Bill Text: IL HB4248 | 2015-2016 | 99th General Assembly | Introduced
Bill Title: Amends the Workers' Compensation Act. Provides that, to obtain compensation under the Act, an employee bears the burden of showing, by a preponderance of the credible evidence, that he or she has sustained accidental injuries arising out of and in the course of the employment and the accidental injuries arising out of and in the course of the employment are the major contributing cause of the medical condition or injury for which compensation is being sought. Defines "major contributing cause". Provides that accidental injuries are not considered to be arising out of and in the course of employment under specified circumstances; adds provisions regarding certain injuries; provides that an injury, its occupational cause, and any resulting manifestations or disability must be established to a reasonable degree of medical certainty, based on objective relevant medical findings; and adds provisions regarding employees who are traveling or on a break. Makes changes regarding workers' compensation insurance. Provides for a reduction of an award by amounts an injured worker has previously received for prior injuries that resulted in permanency awards. Reduces certain payments under fee schedules. Provides that the Illinois Workers' Compensation Commission, rather than the Director of Insurance, shall adopt rules regarding electronic claims. Provides that the Commission shall establish the Workers' Compensation Ombudsman Program within the Commission and sets forth the Program's responsibilities. Creates the Workers' Compensation Edit, Alignment, and Reform Commission to develop a proposed recodification of the Workers' Compensation Act. Provides that the Commission shall procure and implement a computer system to replace its current computer system. Makes changes regarding unlawful acts and penalties. Makes other changes.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-01-03 - Rule 19(b) / Re-referred to Rules Committee [HB4248 Detail]
Download: Illinois-2015-HB4248-Introduced.html
| |||||||||||||||||||||||||
| |||||||||||||||||||||||||
| |||||||||||||||||||||||||
| |||||||||||||||||||||||||
| |||||||||||||||||||||||||
1 | AN ACT concerning employment.
| ||||||||||||||||||||||||
2 | Be it enacted by the People of the State of Illinois,
| ||||||||||||||||||||||||
3 | represented in the General Assembly:
| ||||||||||||||||||||||||
4 | Section 5. The Workers' Compensation Act is amended by | ||||||||||||||||||||||||
5 | changing Sections 1, 4, 8, 8.1b, 8.2, 8.2a, 14, 19, and 25.5 | ||||||||||||||||||||||||
6 | and by adding Sections 14.2, 14.3, and 14.4 as follows:
| ||||||||||||||||||||||||
7 | (820 ILCS 305/1) (from Ch. 48, par. 138.1)
| ||||||||||||||||||||||||
8 | Sec. 1. This Act may be cited as the Workers' Compensation | ||||||||||||||||||||||||
9 | Act.
| ||||||||||||||||||||||||
10 | (a) The term "employer" as used in this Act means:
| ||||||||||||||||||||||||
11 | 1. The State and each county, city, town, township, | ||||||||||||||||||||||||
12 | incorporated
village, school district, body politic, or | ||||||||||||||||||||||||
13 | municipal corporation
therein.
| ||||||||||||||||||||||||
14 | 2. Every person, firm, public or private corporation, | ||||||||||||||||||||||||
15 | including
hospitals, public service, eleemosynary, religious | ||||||||||||||||||||||||
16 | or charitable
corporations or associations who has any person | ||||||||||||||||||||||||
17 | in service or under any
contract for hire, express or implied, | ||||||||||||||||||||||||
18 | oral or written, and who is
engaged in any of the enterprises | ||||||||||||||||||||||||
19 | or businesses enumerated in Section 3
of this Act, or who at or | ||||||||||||||||||||||||
20 | prior to the time of the accident to the
employee for which | ||||||||||||||||||||||||
21 | compensation under this Act may be claimed, has in
the manner | ||||||||||||||||||||||||
22 | provided in this Act elected to become subject to the
| ||||||||||||||||||||||||
23 | provisions of this Act, and who has not, prior to such |
| |||||||
| |||||||
1 | accident,
effected a withdrawal of such election in the manner | ||||||
2 | provided in this Act.
| ||||||
3 | 3. Any one engaging in any business or enterprise referred | ||||||
4 | to in
subsections 1 and 2 of Section 3 of this Act who | ||||||
5 | undertakes to do any
work enumerated therein, is liable to pay | ||||||
6 | compensation to his own
immediate employees in accordance with | ||||||
7 | the provisions of this Act, and
in addition thereto if he | ||||||
8 | directly or indirectly engages any contractor
whether | ||||||
9 | principal or sub-contractor to do any such work, he is liable | ||||||
10 | to
pay compensation to the employees of any such contractor or
| ||||||
11 | sub-contractor unless such contractor or sub-contractor has | ||||||
12 | insured, in
any company or association authorized under the | ||||||
13 | laws of this State to
insure the liability to pay compensation | ||||||
14 | under this Act, or guaranteed
his liability to pay such | ||||||
15 | compensation. With respect to any time
limitation on the filing | ||||||
16 | of claims provided by this Act, the timely
filing of a claim | ||||||
17 | against a contractor or subcontractor, as the case may
be, | ||||||
18 | shall be deemed to be a timely filing with respect to all | ||||||
19 | persons
upon whom liability is imposed by this paragraph.
| ||||||
20 | In the event any such person pays compensation under this | ||||||
21 | subsection
he may recover the amount thereof from the | ||||||
22 | contractor or sub-contractor,
if any, and in the event the | ||||||
23 | contractor pays compensation under this
subsection he may | ||||||
24 | recover the amount thereof from the sub-contractor, if any.
| ||||||
25 | This subsection does not apply in any case where the | ||||||
26 | accident occurs
elsewhere than on, in or about the immediate |
| |||||||
| |||||||
1 | premises on which the
principal has contracted that the work be | ||||||
2 | done.
| ||||||
3 | 4. Where an employer operating under and subject to the | ||||||
4 | provisions
of this Act loans an employee to another such | ||||||
5 | employer and such loaned
employee sustains a compensable | ||||||
6 | accidental injury in the employment of
such borrowing employer | ||||||
7 | and where such borrowing employer does not
provide or pay the | ||||||
8 | benefits or payments due such injured employee, such
loaning | ||||||
9 | employer is liable to provide or pay all benefits or payments
| ||||||
10 | due such employee under this Act and as to such employee the | ||||||
11 | liability
of such loaning and borrowing employers is joint and | ||||||
12 | several, provided
that such loaning employer is in the absence | ||||||
13 | of agreement to the
contrary entitled to receive from such | ||||||
14 | borrowing employer full
reimbursement for all sums paid or | ||||||
15 | incurred pursuant to this paragraph
together with reasonable | ||||||
16 | attorneys' fees and expenses in any hearings
before the | ||||||
17 | Illinois Workers' Compensation Commission or in any action to | ||||||
18 | secure such
reimbursement. Where any benefit is provided or | ||||||
19 | paid by such loaning
employer the employee has the duty of | ||||||
20 | rendering reasonable cooperation
in any hearings, trials or | ||||||
21 | proceedings in the case, including such
proceedings for | ||||||
22 | reimbursement.
| ||||||
23 | Where an employee files an Application for Adjustment of | ||||||
24 | Claim with
the Illinois Workers' Compensation
Commission | ||||||
25 | alleging that his claim is covered by the
provisions of the | ||||||
26 | preceding paragraph, and joining both the alleged
loaning and |
| |||||||
| |||||||
1 | borrowing employers, they and each of them, upon written
demand | ||||||
2 | by the employee and within 7 days after receipt of such demand,
| ||||||
3 | shall have the duty of filing with the Illinois Workers' | ||||||
4 | Compensation Commission a written
admission or denial of the | ||||||
5 | allegation that the claim is covered by the
provisions of the | ||||||
6 | preceding paragraph and in default of such filing or
if any | ||||||
7 | such denial be ultimately determined not to have been bona fide
| ||||||
8 | then the provisions of Paragraph K of Section 19 of this Act | ||||||
9 | shall apply.
| ||||||
10 | An employer whose business or enterprise or a substantial | ||||||
11 | part
thereof consists of hiring, procuring or furnishing | ||||||
12 | employees to or for
other employers operating under and subject | ||||||
13 | to the provisions of this
Act for the performance of the work | ||||||
14 | of such other employers and who pays
such employees their | ||||||
15 | salary or wages notwithstanding that they are doing
the work of | ||||||
16 | such other employers shall be deemed a loaning employer
within | ||||||
17 | the meaning and provisions of this Section.
| ||||||
18 | (b) The term "employee" as used in this Act means:
| ||||||
19 | 1. Every person in the service of the State, including | ||||||
20 | members of
the General Assembly, members of the Commerce | ||||||
21 | Commission, members of the
Illinois Workers' Compensation | ||||||
22 | Commission, and all persons in the service of the University
of | ||||||
23 | Illinois, county, including deputy sheriffs and assistant | ||||||
24 | state's
attorneys, city, town, township, incorporated village | ||||||
25 | or school
district, body politic, or municipal corporation | ||||||
26 | therein, whether by
election, under appointment or contract of |
| |||||||
| |||||||
1 | hire, express or implied,
oral or written, including all | ||||||
2 | members of the Illinois National Guard
while on active duty in | ||||||
3 | the service of the State, and all probation
personnel of the | ||||||
4 | Juvenile Court appointed pursuant to Article VI
of the Juvenile | ||||||
5 | Court Act of 1987, and including any official of the
State, any | ||||||
6 | county, city, town, township, incorporated village, school
| ||||||
7 | district, body politic or municipal corporation therein except | ||||||
8 | any duly
appointed member of a police department in any city | ||||||
9 | whose
population exceeds 500,000 according to the last Federal | ||||||
10 | or State
census, and except any member of a fire insurance | ||||||
11 | patrol maintained by a
board of underwriters in this State. A | ||||||
12 | duly appointed member of a fire
department in any city, the | ||||||
13 | population of which exceeds 500,000 according
to the last | ||||||
14 | federal or State census, is an employee under this Act only
| ||||||
15 | with respect to claims brought under paragraph (c) of Section | ||||||
16 | 8.
| ||||||
17 | One employed by a contractor who has contracted with the | ||||||
18 | State, or a
county, city, town, township, incorporated village, | ||||||
19 | school district,
body politic or municipal corporation | ||||||
20 | therein, through its
representatives, is not considered as an | ||||||
21 | employee of the State, county,
city, town, township, | ||||||
22 | incorporated village, school district, body
politic or | ||||||
23 | municipal corporation which made the contract.
| ||||||
24 | 2. Every person in the service of another under any | ||||||
25 | contract of
hire, express or implied, oral or written, | ||||||
26 | including persons whose
employment is outside of the State of |
| |||||||
| |||||||
1 | Illinois where the contract of
hire is made within the State of | ||||||
2 | Illinois, persons whose employment
results in fatal or | ||||||
3 | non-fatal injuries within the State of Illinois
where the | ||||||
4 | contract of hire is made outside of the State of Illinois, and
| ||||||
5 | persons whose employment is principally localized within the | ||||||
6 | State of
Illinois, regardless of the place of the accident or | ||||||
7 | the place where the
contract of hire was made, and including | ||||||
8 | aliens, and minors who, for the
purpose of this Act are | ||||||
9 | considered the same and have the same power to
contract, | ||||||
10 | receive payments and give quittances therefor, as adult | ||||||
11 | employees.
| ||||||
12 | 3. Every sole proprietor and every partner of a business | ||||||
13 | may elect to
be covered by this Act.
| ||||||
14 | An employee or his dependents under this Act who shall have | ||||||
15 | a cause
of action by reason of any injury, disablement or death | ||||||
16 | arising out of
and in the course of his employment may elect to | ||||||
17 | pursue his remedy in
the State where injured or disabled, or in | ||||||
18 | the State where the contract
of hire is made, or in the State | ||||||
19 | where the employment is principally
localized.
| ||||||
20 | However, any employer may elect to provide and pay | ||||||
21 | compensation to
any employee other than those engaged in the | ||||||
22 | usual course of the trade,
business, profession or occupation | ||||||
23 | of the employer by complying with
Sections 2 and 4 of this Act. | ||||||
24 | Employees are not included within the
provisions of this Act | ||||||
25 | when excluded by the laws of the United States
relating to | ||||||
26 | liability of employers to their employees for personal
injuries |
| |||||||
| |||||||
1 | where such laws are held to be exclusive.
| ||||||
2 | The term "employee" does not include persons performing | ||||||
3 | services as real
estate broker, broker-salesman, or salesman | ||||||
4 | when such persons are paid by
commission only.
| ||||||
5 | (c) "Commission" means the Industrial Commission created | ||||||
6 | by Section
5 of "The Civil Administrative Code of Illinois", | ||||||
7 | approved March 7,
1917, as amended, or the Illinois Workers' | ||||||
8 | Compensation Commission created by Section 13 of
this Act.
| ||||||
9 | (d) (1) To obtain compensation under this Act, an employee | ||||||
10 | bears the burden of showing, by a preponderance of the credible | ||||||
11 | evidence, that (i) he or she has sustained accidental injuries | ||||||
12 | arising out of and in the course of the employment and (ii) the | ||||||
13 | accidental injuries arising out of and in the course of the | ||||||
14 | employment are the major contributing cause of the medical | ||||||
15 | condition or injury for which compensation is being sought. The | ||||||
16 | "major contributing cause" of a medical condition or injury is | ||||||
17 | the cause that is greater than 50% of all combined causes of | ||||||
18 | the medical condition or injury . | ||||||
19 | Accidental injuries shall not be considered to be "arising | ||||||
20 | out of and in the course of employment" if, without limitation: | ||||||
21 | (A) the accident resulted from a hazard or risk that was not | ||||||
22 | incidental to the employment or the accident resulted from a | ||||||
23 | hazard or risk to which the general public is also exposed, (B) | ||||||
24 | the accident did not occur at a time and place and under | ||||||
25 | circumstances reasonably required by the employment, or (C) the | ||||||
26 | medical condition or injury for which compensation is being |
| |||||||
| |||||||
1 | sought resulted from a personal or neutral risk. | ||||||
2 | (2) For the purposes of clause (ii) of paragraph (1) only, | ||||||
3 | if an employee has suffered cumulative or repetitive accidental | ||||||
4 | injuries while employed in the same occupation or industry by | ||||||
5 | multiple employers over time, the accidental injuries arising | ||||||
6 | out of and in the course of the employment shall be considered | ||||||
7 | to be the major contributing cause of the medical condition or | ||||||
8 | injury for which compensation is being sought if those | ||||||
9 | cumulative or repetitive accidental injuries suffered during | ||||||
10 | employment in that occupation or industry are greater than 50% | ||||||
11 | of all combined causes of the medical condition or injury. In | ||||||
12 | that circumstance, the employer liable for compensation under | ||||||
13 | this Act shall be the most recent current or former employer | ||||||
14 | who has employed the employee for at least 3 months. | ||||||
15 | (3) An injury, its occupational cause, and any resulting | ||||||
16 | manifestations or disability must be established to a | ||||||
17 | reasonable degree of medical certainty, based on objective | ||||||
18 | relevant medical findings. | ||||||
19 | (e) An employee who is required to travel in connection | ||||||
20 | with his or her employment and who suffers an injury while in | ||||||
21 | travel status shall be eligible for benefits only if the injury | ||||||
22 | arises out of and in the course of employment and the travel is | ||||||
23 | necessary for the performance of job duties. Travel is | ||||||
24 | necessary for the performance of job duties if (i) the employer | ||||||
25 | furnishes the transportation or the employee receives | ||||||
26 | reimbursement from the employer for costs of travel, gas, or |
| |||||||
| |||||||
1 | lodging as part of the employee's benefits or employment | ||||||
2 | agreement and (ii) travel is required by the employer as part | ||||||
3 | of the employee's job duties. | ||||||
4 | An injury suffered by a traveling employee is deemed to | ||||||
5 | arise out of his or her employment if caused by a risk | ||||||
6 | incidental to or connected with the employment. Risk is not to | ||||||
7 | be determined by a reasonable and foreseeable standard. | ||||||
8 | Arising in and out of the course of employment does not | ||||||
9 | include travel to and from work or when an employee is on a | ||||||
10 | paid or unpaid break and is not performing any specific tasks | ||||||
11 | for the employer during the break. Common risks associated with | ||||||
12 | travel even where the traveling employee is exposed to a | ||||||
13 | greater degree than the general public do not arise out of the | ||||||
14 | employment. | ||||||
15 | (Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813, | ||||||
16 | eff. 7-13-12.)
| ||||||
17 | (820 ILCS 305/4) (from Ch. 48, par. 138.4)
| ||||||
18 | Sec. 4. (a) Any employer, including but not limited to | ||||||
19 | general contractors
and their subcontractors, who shall come | ||||||
20 | within the provisions of
Section 3 of this Act, and any other | ||||||
21 | employer who shall elect to provide
and pay the compensation | ||||||
22 | provided for in this Act shall:
| ||||||
23 | (1) File with the Commission annually an application | ||||||
24 | for approval as a
self-insurer which shall include a | ||||||
25 | current financial statement, and
annually, thereafter, an |
| |||||||
| |||||||
1 | application for renewal of self-insurance, which
shall | ||||||
2 | include a current financial statement. Said
application | ||||||
3 | and financial statement shall be signed and sworn to by the
| ||||||
4 | president or vice president and secretary or assistant | ||||||
5 | secretary of the
employer if it be a corporation, or by all | ||||||
6 | of the partners, if it be a
copartnership, or by the owner | ||||||
7 | if it be neither a copartnership nor a
corporation. All | ||||||
8 | initial applications and all applications for renewal of
| ||||||
9 | self-insurance must be submitted at least 60 days prior to | ||||||
10 | the requested
effective date of self-insurance. An | ||||||
11 | employer may elect to provide and pay
compensation as | ||||||
12 | provided
for in this Act as a member of a group workers' | ||||||
13 | compensation pool under Article
V 3/4 of the Illinois | ||||||
14 | Insurance Code. If an employer becomes a member of a
group | ||||||
15 | workers' compensation pool, the employer shall not be | ||||||
16 | relieved of any
obligations imposed by this Act.
| ||||||
17 | If the sworn application and financial statement of any | ||||||
18 | such employer
does not satisfy the Commission of the | ||||||
19 | financial ability of the employer
who has filed it, the | ||||||
20 | Commission shall require such employer to,
| ||||||
21 | (2) Furnish security, indemnity or a bond guaranteeing | ||||||
22 | the payment
by the employer of the compensation provided | ||||||
23 | for in this Act, provided
that any such employer whose | ||||||
24 | application and financial statement shall
not have | ||||||
25 | satisfied the commission of his or her financial ability | ||||||
26 | and
who shall have secured his liability in part by excess |
| |||||||
| |||||||
1 | workers' compensation liability insurance
shall be | ||||||
2 | required to furnish to the Commission security, indemnity | ||||||
3 | or bond
guaranteeing his or her payment up to the effective | ||||||
4 | limits of the excess
coverage, or
| ||||||
5 | (3) Insure his entire liability to pay such | ||||||
6 | compensation in some
workers' compensation insurance | ||||||
7 | carrier authorized, licensed, or permitted to do such
| ||||||
8 | insurance business in this State. Every policy of a | ||||||
9 | workers' compensation an insurance carrier,
insuring the | ||||||
10 | payment of compensation under this Act shall cover all the
| ||||||
11 | employees and the entire compensation liability of the | ||||||
12 | insured:
Provided, however, that any employer may insure | ||||||
13 | his or her compensation
liability with 2 or more workers' | ||||||
14 | compensation insurance carriers or may insure a part and
| ||||||
15 | qualify under subsection 1, 2, or 4 for the remainder of | ||||||
16 | his or her
liability to pay such compensation, subject to | ||||||
17 | the following two provisions:
| ||||||
18 | Firstly, the entire compensation liability of the | ||||||
19 | employer to
employees working at or from one location | ||||||
20 | shall be insured in one such
workers' compensation | ||||||
21 | insurance carrier or shall be self-insured, and
| ||||||
22 | Secondly, the employer shall submit evidence | ||||||
23 | satisfactorily to the
Commission that his or her entire | ||||||
24 | liability for the compensation provided
for in this Act | ||||||
25 | will be secured. Any provisions in any policy, or in | ||||||
26 | any
endorsement attached thereto, attempting to limit |
| |||||||
| |||||||
1 | or modify in any way,
the liability of the workers' | ||||||
2 | compensation insurance carriers issuing the same | ||||||
3 | except as
otherwise provided herein shall be wholly | ||||||
4 | void.
| ||||||
5 | Nothing herein contained shall apply to policies of | ||||||
6 | excess liability
carriage secured by employers who have | ||||||
7 | been approved by the Commission
as self-insurers, or
| ||||||
8 | (4) Make some other provision, satisfactory to the | ||||||
9 | Commission, for
the securing of the payment of compensation | ||||||
10 | provided for in this Act,
and
| ||||||
11 | (5) Upon becoming subject to this Act and thereafter as | ||||||
12 | often as the
Commission may in writing demand, file with | ||||||
13 | the Commission in form prescribed
by it evidence of his or | ||||||
14 | her compliance with the provision of this Section.
| ||||||
15 | (a-1) Regardless of its state of domicile or its principal | ||||||
16 | place of
business, an employer shall make payments to its | ||||||
17 | workers' compensation insurance carrier or group
| ||||||
18 | self-insurance fund, where applicable, based upon the premium | ||||||
19 | rates of the
situs where the work or project is located in | ||||||
20 | Illinois if:
| ||||||
21 | (A) the employer is engaged primarily in the building | ||||||
22 | and
construction industry; and
| ||||||
23 | (B) subdivision (a)(3) of this Section applies to the | ||||||
24 | employer or
the employer is a member of a group | ||||||
25 | self-insurance plan as defined in
subsection (1) of Section | ||||||
26 | 4a.
|
| |||||||
| |||||||
1 | The Illinois Workers' Compensation Commission shall impose | ||||||
2 | a penalty upon an employer
for violation of this subsection | ||||||
3 | (a-1) if:
| ||||||
4 | (i) the employer is given an opportunity at a hearing | ||||||
5 | to present
evidence of its compliance with this subsection | ||||||
6 | (a-1); and
| ||||||
7 | (ii) after the hearing, the Commission finds that the | ||||||
8 | employer
failed to make payments upon the premium rates of | ||||||
9 | the situs where the work or
project is located in Illinois.
| ||||||
10 | The penalty shall not exceed $1,000 for each day of work | ||||||
11 | for which
the employer failed to make payments upon the premium | ||||||
12 | rates of the situs where
the
work or project is located in | ||||||
13 | Illinois, but the total penalty shall not exceed
$50,000 for | ||||||
14 | each project or each contract under which the work was
| ||||||
15 | performed.
| ||||||
16 | Any penalty under this subsection (a-1) must be imposed not | ||||||
17 | later
than one year after the expiration of the applicable | ||||||
18 | limitation period
specified in subsection (d) of Section 6 of | ||||||
19 | this Act. Penalties imposed under
this subsection (a-1) shall | ||||||
20 | be deposited into the Illinois Workers' Compensation | ||||||
21 | Commission
Operations Fund, a special fund that is created in | ||||||
22 | the State treasury. Subject
to appropriation, moneys in the | ||||||
23 | Fund shall be used solely for the operations
of the Illinois | ||||||
24 | Workers' Compensation Commission and by the Department of | ||||||
25 | Insurance for the purposes authorized in subsection (c) of | ||||||
26 | Section 25.5 of this Act.
|
| |||||||
| |||||||
1 | (a-2) Every Employee Leasing Company (ELC), as defined in | ||||||
2 | Section 15 of the Employee Leasing Company Act, shall at a | ||||||
3 | minimum provide the following information to the Commission or | ||||||
4 | any entity designated by the Commission regarding each workers' | ||||||
5 | compensation insurance policy issued to the ELC: | ||||||
6 | (1) Any client company of the ELC listed as an | ||||||
7 | additional named insured. | ||||||
8 | (2) Any informational schedule attached to the master | ||||||
9 | policy that identifies any individual client company's | ||||||
10 | name, FEIN, and job location. | ||||||
11 | (3) Any certificate of workers' compensation insurance | ||||||
12 | coverage document issued to a client company specifying its | ||||||
13 | rights and obligations under the master policy that | ||||||
14 | establishes both the identity and status of the client, as | ||||||
15 | well as the dates of inception and termination of coverage, | ||||||
16 | if applicable. | ||||||
17 | (b) The sworn application and financial statement, or | ||||||
18 | security,
indemnity or bond, or amount of insurance, or other | ||||||
19 | provisions, filed,
furnished, carried, or made by the employer, | ||||||
20 | as the case may be, shall
be subject to the approval of the | ||||||
21 | Commission.
| ||||||
22 | Deposits under escrow agreements shall be cash, negotiable | ||||||
23 | United
States government bonds or negotiable general | ||||||
24 | obligation bonds of the
State of Illinois. Such cash or bonds | ||||||
25 | shall be deposited in
escrow with any State or National Bank or | ||||||
26 | Trust Company having trust
authority in the State of Illinois.
|
| |||||||
| |||||||
1 | Upon the approval of the sworn application and financial | ||||||
2 | statement,
security, indemnity or bond or amount of insurance, | ||||||
3 | filed, furnished or
carried, as the case may be, the Commission | ||||||
4 | shall send to the employer
written notice of its approval | ||||||
5 | thereof. The certificate of compliance
by the employer with the | ||||||
6 | provisions of subparagraphs (2) and (3) of
paragraph (a) of | ||||||
7 | this Section shall be delivered by the workers' compensation | ||||||
8 | insurance
carrier to the Illinois Workers' Compensation | ||||||
9 | Commission within five days after the
effective date of the | ||||||
10 | policy so certified. The workers' compensation insurance so | ||||||
11 | certified
shall cover all compensation liability occurring | ||||||
12 | during the time that
the insurance is in effect and no further | ||||||
13 | certificate need be filed in case
such insurance is renewed, | ||||||
14 | extended or otherwise continued by such
carrier. The insurance | ||||||
15 | so certified shall not be cancelled or in the
event that such | ||||||
16 | insurance is not renewed, extended or otherwise
continued, such | ||||||
17 | insurance shall not be terminated until at least 10
days after | ||||||
18 | receipt by the Illinois Workers' Compensation Commission of | ||||||
19 | notice of the
cancellation or termination of said insurance; | ||||||
20 | provided, however, that
if the employer has secured insurance | ||||||
21 | from another workers' compensation insurance carrier, or
has | ||||||
22 | otherwise secured the payment of compensation in accordance | ||||||
23 | with
this Section, and such insurance or other security becomes | ||||||
24 | effective
prior to the expiration of the 10 days, cancellation | ||||||
25 | or termination may, at
the option of the insurance carrier | ||||||
26 | indicated in such notice, be effective
as of the effective date |
| |||||||
| |||||||
1 | of such other insurance or security.
| ||||||
2 | (c) Whenever the Commission shall find that any | ||||||
3 | corporation,
company, association, aggregation of individuals, | ||||||
4 | reciprocal or
interinsurers exchange, or other insurer | ||||||
5 | effecting workers' compensation
insurance in this State shall | ||||||
6 | be insolvent, financially unsound, or
unable to fully meet all | ||||||
7 | payments and liabilities assumed or to be
assumed for workers' | ||||||
8 | compensation insurance in this State, or shall practice a
| ||||||
9 | policy of delay or unfairness toward employees in the | ||||||
10 | adjustment,
settlement, or payment of benefits due such | ||||||
11 | employees, the Commission
may after reasonable notice and | ||||||
12 | hearing order and direct that such
corporation, company, | ||||||
13 | association, aggregation of individuals,
reciprocal or | ||||||
14 | interinsurers exchange, or insurer, shall from and after a
date | ||||||
15 | fixed in such order discontinue the writing of any such | ||||||
16 | workers'
compensation insurance in this State. Subject to such | ||||||
17 | modification of
the order as the Commission may later make on | ||||||
18 | review of the order,
as herein provided, it shall thereupon be | ||||||
19 | unlawful for any such
corporation, company, association, | ||||||
20 | aggregation of individuals,
reciprocal or interinsurers | ||||||
21 | exchange, or insurer to effect any workers'
compensation | ||||||
22 | insurance in this State. A copy of the order shall be served
| ||||||
23 | upon the Director of Insurance by registered mail. Whenever the | ||||||
24 | Commission
finds that any service or adjustment company used or | ||||||
25 | employed
by a self-insured employer or by an insurance carrier | ||||||
26 | to process,
adjust, investigate, compromise or otherwise |
| |||||||
| |||||||
1 | handle claims under this
Act, has practiced or is practicing a | ||||||
2 | policy of delay or unfairness
toward employees in the | ||||||
3 | adjustment, settlement or payment of benefits
due such | ||||||
4 | employees, the Commission may after reasonable notice and
| ||||||
5 | hearing order and direct that such service or adjustment | ||||||
6 | company shall
from and after a date fixed in such order be | ||||||
7 | prohibited from processing,
adjusting, investigating, | ||||||
8 | compromising or otherwise handling claims
under this Act.
| ||||||
9 | Whenever the Commission finds that any self-insured | ||||||
10 | employer has
practiced or is practicing delay or unfairness | ||||||
11 | toward employees in the
adjustment, settlement or payment of | ||||||
12 | benefits due such employees, the
Commission may, after | ||||||
13 | reasonable notice and hearing, order and direct
that after a | ||||||
14 | date fixed in the order such self-insured employer shall be
| ||||||
15 | disqualified to operate as a self-insurer and shall be required | ||||||
16 | to
insure his entire liability to pay compensation in some | ||||||
17 | workers' compensation insurance
carrier authorized, licensed | ||||||
18 | and permitted to do such insurance business
in this State, as | ||||||
19 | provided in subparagraph 3 of paragraph (a) of this
Section.
| ||||||
20 | All orders made by the Commission under this Section shall | ||||||
21 | be subject
to review by the courts, said review to be taken in | ||||||
22 | the same manner and
within the same time as provided by Section | ||||||
23 | 19 of this Act for review of
awards and decisions of the | ||||||
24 | Commission, upon the party seeking the
review filing with the | ||||||
25 | clerk of the court to which said review is taken
a bond in an | ||||||
26 | amount to be fixed and approved by the court to which the
|
| |||||||
| |||||||
1 | review is taken, conditioned upon the payment of all | ||||||
2 | compensation awarded
against the person taking said review | ||||||
3 | pending a decision thereof and
further conditioned upon such | ||||||
4 | other obligations as the court may impose.
Upon the review the | ||||||
5 | Circuit Court shall have power to review all questions
of fact | ||||||
6 | as well as of law. The penalty hereinafter provided for in this
| ||||||
7 | paragraph shall not attach and shall not begin to run until the | ||||||
8 | final
determination of the order of the Commission.
| ||||||
9 | (d) Whenever a panel of 3 Commissioners comprised of one | ||||||
10 | member of the employing class, one member of the employee | ||||||
11 | class, and one member not identified with either the employing | ||||||
12 | or employee class, with due process and after a hearing, | ||||||
13 | determines an employer has knowingly failed to provide coverage | ||||||
14 | as required by paragraph (a) of this Section, the failure shall | ||||||
15 | be deemed an immediate serious danger to public health, safety, | ||||||
16 | and welfare sufficient to justify service by the Commission of | ||||||
17 | a work-stop order on such employer, requiring the cessation of | ||||||
18 | all business operations of such employer at the place of | ||||||
19 | employment or job site. Any law enforcement agency in the State | ||||||
20 | shall, at the request of the Commission, render any assistance | ||||||
21 | necessary to carry out the provisions of this Section, | ||||||
22 | including, but not limited to, preventing any employee of such | ||||||
23 | employer from remaining at a place of employment or job site | ||||||
24 | after a work-stop order has taken effect. Any work-stop order | ||||||
25 | shall be lifted upon proof of workers' compensation insurance | ||||||
26 | as required by this Act. Any orders under this Section are |
| |||||||
| |||||||
1 | appealable under Section 19(f) to the Circuit Court.
| ||||||
2 | Any individual employer, corporate officer or director of a | ||||||
3 | corporate employer, partner of an employer partnership, or | ||||||
4 | member of an employer limited liability company who knowingly | ||||||
5 | fails to provide coverage as required by paragraph (a) of this | ||||||
6 | Section is guilty of a Class 4 felony. This provision shall not | ||||||
7 | apply to any corporate officer or director of any | ||||||
8 | publicly-owned corporation. Each day's violation constitutes a | ||||||
9 | separate offense. The State's Attorney of the county in which | ||||||
10 | the violation occurred, or the Attorney General, shall bring | ||||||
11 | such actions in the name of the People of the State of | ||||||
12 | Illinois, or may, in addition to other remedies provided in | ||||||
13 | this Section, bring an action for an injunction to restrain the | ||||||
14 | violation or to enjoin the operation of any such employer.
| ||||||
15 | Any individual employer, corporate officer or director of a | ||||||
16 | corporate employer, partner of an employer partnership, or | ||||||
17 | member of an employer limited liability company who negligently | ||||||
18 | fails to provide coverage as required by paragraph (a) of this | ||||||
19 | Section is guilty of a Class A misdemeanor. This provision | ||||||
20 | shall not apply to any corporate officer or director of any | ||||||
21 | publicly-owned corporation. Each day's violation constitutes a | ||||||
22 | separate offense. The State's Attorney of the county in which | ||||||
23 | the violation occurred, or the Attorney General, shall bring | ||||||
24 | such actions in the name of the People of the State of | ||||||
25 | Illinois.
| ||||||
26 | The criminal penalties in this subsection (d) shall not |
| |||||||
| |||||||
1 | apply where
there exists a good faith dispute as to the | ||||||
2 | existence of an
employment relationship. Evidence of good faith | ||||||
3 | shall
include, but not be limited to, compliance with the | ||||||
4 | definition
of employee as used by the Internal Revenue Service.
| ||||||
5 | Employers who are subject to and who knowingly fail to | ||||||
6 | comply with this Section shall not be entitled to the benefits | ||||||
7 | of this Act during the period of noncompliance, but shall be | ||||||
8 | liable in an action under any other applicable law of this | ||||||
9 | State. In the action, such employer shall not avail himself or | ||||||
10 | herself of the defenses of assumption of risk or negligence or | ||||||
11 | that the injury was due to a co-employee. In the action, proof | ||||||
12 | of the injury shall constitute prima facie evidence of | ||||||
13 | negligence on the part of such employer and the burden shall be | ||||||
14 | on such employer to show freedom of negligence resulting in the | ||||||
15 | injury. The employer shall not join any other defendant in any | ||||||
16 | such civil action. Nothing in this amendatory Act of the 94th | ||||||
17 | General Assembly shall affect the employee's rights under | ||||||
18 | subdivision (a)3 of Section 1 of this Act. Any employer or | ||||||
19 | carrier who makes payments under subdivision (a)3 of Section 1 | ||||||
20 | of this Act shall have a right of reimbursement from the | ||||||
21 | proceeds of any recovery under this Section.
| ||||||
22 | An employee of an uninsured employer, or the employee's | ||||||
23 | dependents in case death ensued, may, instead of proceeding | ||||||
24 | against the employer in a civil action in court, file an | ||||||
25 | application for adjustment of claim with the Commission in | ||||||
26 | accordance with the provisions of this Act and the Commission |
| |||||||
| |||||||
1 | shall hear and determine the application for adjustment of | ||||||
2 | claim in the manner in which other claims are heard and | ||||||
3 | determined before the Commission.
| ||||||
4 | All proceedings under this subsection (d) shall be reported | ||||||
5 | on an annual basis to the Workers' Compensation Advisory Board.
| ||||||
6 | An investigator with the Illinois Workers' Compensation | ||||||
7 | Commission Insurance Compliance Division may issue a citation | ||||||
8 | to any employer that is not in compliance with its obligation | ||||||
9 | to have workers' compensation insurance under this Act. The | ||||||
10 | amount of the fine shall be based on the period of time the | ||||||
11 | employer was in non-compliance, but shall be no less than $500, | ||||||
12 | and shall not exceed $2,500. An employer that has been issued a | ||||||
13 | citation shall pay the fine to the Commission and provide to | ||||||
14 | the Commission proof that it obtained the required workers' | ||||||
15 | compensation insurance within 10 days after the citation was | ||||||
16 | issued. This Section does not affect any other obligations this | ||||||
17 | Act imposes on employers. | ||||||
18 | Upon a finding by the Commission, after reasonable notice | ||||||
19 | and
hearing, of the knowing and wilful failure or refusal of an | ||||||
20 | employer to
comply with
any of the provisions of paragraph (a) | ||||||
21 | of this Section, the failure or
refusal of an employer, service | ||||||
22 | or adjustment company, or an insurance
carrier to comply with | ||||||
23 | any order of the Illinois Workers' Compensation Commission | ||||||
24 | pursuant to
paragraph (c) of this Section disqualifying him or | ||||||
25 | her to operate as a self
insurer and requiring him or her to | ||||||
26 | insure his or her liability, or the knowing and willful failure |
| |||||||
| |||||||
1 | of an employer to comply with a citation issued by an | ||||||
2 | investigator with the Illinois Workers' Compensation | ||||||
3 | Commission Insurance Compliance Division, the
Commission may | ||||||
4 | assess a civil penalty of up to $500 per day for each day of
| ||||||
5 | such failure or refusal after the effective date of this | ||||||
6 | amendatory Act of
1989. The minimum penalty under this Section | ||||||
7 | shall be the sum of $10,000.
Each day of such failure or | ||||||
8 | refusal shall constitute a separate offense.
The Commission may | ||||||
9 | assess the civil penalty personally and individually
against | ||||||
10 | the corporate officers and directors of a corporate employer, | ||||||
11 | the
partners of an employer partnership, and the members of an | ||||||
12 | employer limited
liability company, after a finding of a | ||||||
13 | knowing and willful refusal or failure
of each such named | ||||||
14 | corporate officer, director, partner, or member to comply
with | ||||||
15 | this Section. The liability for the assessed penalty shall be
| ||||||
16 | against the named employer first, and
if the named employer | ||||||
17 | fails or refuses to pay the penalty to the
Commission within 30 | ||||||
18 | days after the final order of the Commission, then the
named
| ||||||
19 | corporate officers, directors, partners, or members who have | ||||||
20 | been found to have
knowingly and willfully refused or failed to | ||||||
21 | comply with this Section shall be
liable for the unpaid penalty | ||||||
22 | or any unpaid portion of the penalty. Upon investigation by the | ||||||
23 | insurance non-compliance unit of the Commission, the Attorney | ||||||
24 | General shall have the authority to prosecute all proceedings | ||||||
25 | to enforce the civil and administrative provisions of this | ||||||
26 | Section before the Commission. The Commission shall promulgate |
| |||||||
| |||||||
1 | procedural rules for enforcing this Section.
| ||||||
2 | Upon the failure or refusal of any employer, service or | ||||||
3 | adjustment
company or insurance carrier to comply with the | ||||||
4 | provisions of this Section
and with the orders of the | ||||||
5 | Commission under this Section, or the order of
the court on | ||||||
6 | review after final adjudication, the Commission may bring a
| ||||||
7 | civil action to recover the amount of the penalty in Cook | ||||||
8 | County or in
Sangamon County in which litigation the Commission | ||||||
9 | shall be represented by
the Attorney General. The Commission | ||||||
10 | shall send notice of its finding of
non-compliance and | ||||||
11 | assessment of the civil penalty to the Attorney General.
It | ||||||
12 | shall be the duty of the Attorney General within 30 days after | ||||||
13 | receipt
of the notice, to institute prosecutions and promptly | ||||||
14 | prosecute all
reported violations of this Section.
| ||||||
15 | Any individual employer, corporate officer or director of a | ||||||
16 | corporate employer, partner of an employer partnership, or | ||||||
17 | member of an employer limited liability company who, with the | ||||||
18 | intent to avoid payment of compensation under this Act to an | ||||||
19 | injured employee or the employee's dependents, knowingly | ||||||
20 | transfers, sells, encumbers, assigns, or in any manner disposes | ||||||
21 | of, conceals, secretes, or destroys any property belonging to | ||||||
22 | the employer, officer, director, partner, or member is guilty | ||||||
23 | of a Class 4 felony.
| ||||||
24 | Penalties and fines collected pursuant to this paragraph | ||||||
25 | (d) shall be deposited upon receipt into a special fund which | ||||||
26 | shall be designated the Injured Workers' Benefit Fund, of which |
| |||||||
| |||||||
1 | the State Treasurer is ex-officio custodian, such special fund | ||||||
2 | to be held and disbursed in accordance with this paragraph (d) | ||||||
3 | for the purposes hereinafter stated in this paragraph (d), upon | ||||||
4 | the final order of the Commission. The Injured Workers' Benefit | ||||||
5 | Fund shall be deposited the same as are State funds and any | ||||||
6 | interest accruing thereon shall be added thereto every 6 | ||||||
7 | months. The Injured Workers' Benefit Fund is subject to audit | ||||||
8 | the same as State funds and accounts and is protected by the | ||||||
9 | general bond given by the State Treasurer. The Injured Workers' | ||||||
10 | Benefit Fund is considered always appropriated for the purposes | ||||||
11 | of disbursements as provided in this paragraph, and shall be | ||||||
12 | paid out and disbursed as herein provided and shall not at any | ||||||
13 | time be appropriated or diverted to any other use or purpose. | ||||||
14 | Moneys in the Injured Workers' Benefit Fund shall be used only | ||||||
15 | for payment of workers' compensation benefits for injured | ||||||
16 | employees when the employer has failed to provide coverage as | ||||||
17 | determined under this paragraph (d) and has failed to pay the | ||||||
18 | benefits due to the injured employee. The Commission shall have | ||||||
19 | the right to obtain reimbursement from the employer for | ||||||
20 | compensation obligations paid by the Injured Workers' Benefit | ||||||
21 | Fund. Any such amounts obtained shall be deposited by the | ||||||
22 | Commission into the Injured Workers' Benefit Fund. If an | ||||||
23 | injured employee or his or her personal representative receives | ||||||
24 | payment from the Injured Workers' Benefit Fund, the State of | ||||||
25 | Illinois has the same rights under paragraph (b) of Section 5 | ||||||
26 | that the employer who failed to pay the benefits due to the |
| |||||||
| |||||||
1 | injured employee would have had if the employer had paid those | ||||||
2 | benefits, and any moneys recovered by the State as a result of | ||||||
3 | the State's exercise of its rights under paragraph (b) of | ||||||
4 | Section 5 shall be deposited into the Injured Workers' Benefit | ||||||
5 | Fund. The custodian of the Injured Workers' Benefit Fund shall | ||||||
6 | be joined with the employer as a party respondent in the | ||||||
7 | application for adjustment of claim. After July 1, 2006, the | ||||||
8 | Commission shall make disbursements from the Fund once each | ||||||
9 | year to each eligible claimant. An eligible claimant is an | ||||||
10 | injured worker who has within the previous fiscal year obtained | ||||||
11 | a final award for benefits from the Commission against the | ||||||
12 | employer and the Injured Workers' Benefit Fund and has notified | ||||||
13 | the Commission within 90 days of receipt of such award. Within | ||||||
14 | a reasonable time after the end of each fiscal year, the | ||||||
15 | Commission shall make a disbursement to each eligible claimant. | ||||||
16 | At the time of disbursement, if there are insufficient moneys | ||||||
17 | in the Fund to pay all claims, each eligible claimant shall | ||||||
18 | receive a pro-rata share, as determined by the Commission, of | ||||||
19 | the available moneys in the Fund for that year. Payment from | ||||||
20 | the Injured Workers' Benefit Fund to an eligible claimant | ||||||
21 | pursuant to this provision shall discharge the obligations of | ||||||
22 | the Injured Workers' Benefit Fund regarding the award entered | ||||||
23 | by the Commission.
| ||||||
24 | (e) This Act shall not affect or disturb the continuance of | ||||||
25 | any
existing workers' compensation insurance, mutual aid, | ||||||
26 | benefit, or relief association or
department, whether |
| |||||||
| |||||||
1 | maintained in whole or in part by the employer or
whether | ||||||
2 | maintained by the employees, the payment of benefits of such
| ||||||
3 | association or department being guaranteed by the employer or | ||||||
4 | by some
person, firm or corporation for him or her: Provided, | ||||||
5 | the employer contributes
to such association or department an | ||||||
6 | amount not less than the full
compensation herein provided, | ||||||
7 | exclusive of the cost of the maintenance
of such association or | ||||||
8 | department and without any expense to the
employee. This Act | ||||||
9 | shall not prevent the organization and maintaining
under the | ||||||
10 | insurance laws of this State of any benefit or insurance
| ||||||
11 | company for the purpose of insuring against the compensation | ||||||
12 | provided
for in this Act, the expense of which is maintained by | ||||||
13 | the employer.
This Act shall not prevent the organization or | ||||||
14 | maintaining under the
insurance laws of this State of any | ||||||
15 | voluntary mutual aid, benefit or
relief association among | ||||||
16 | employees for the payment of additional
accident or sick | ||||||
17 | benefits.
| ||||||
18 | (f) No existing workers' compensation insurance, mutual | ||||||
19 | aid, benefit or relief association
or department shall, by | ||||||
20 | reason of anything herein contained, be
authorized to | ||||||
21 | discontinue its operation without first discharging its
| ||||||
22 | obligations to any and all persons carrying insurance in the | ||||||
23 | same or
entitled to relief or benefits therein.
| ||||||
24 | (g) Any contract, oral, written or implied, of employment | ||||||
25 | providing
for relief benefit, or workers' compensation | ||||||
26 | insurance or any other device whereby the
employee is required |
| |||||||
| |||||||
1 | to pay any premium or premiums for insurance
against the | ||||||
2 | compensation provided for in this Act shall be null and
void. | ||||||
3 | Any employer withholding from the wages of any employee any
| ||||||
4 | amount for the purpose of paying any such premium shall be | ||||||
5 | guilty of a
Class B misdemeanor.
| ||||||
6 | In the event the employer does not pay the compensation for | ||||||
7 | which he or
she is liable, then a workers' compensation an | ||||||
8 | insurance company, association or insurer which may
have | ||||||
9 | insured such employer against such liability shall become | ||||||
10 | primarily
liable to pay to the employee, his or her personal | ||||||
11 | representative or
beneficiary the compensation required by the | ||||||
12 | provisions of this Act to
be paid by such employer. The | ||||||
13 | insurance carrier may be made a party to
the proceedings in | ||||||
14 | which the employer is a party and an award may be
entered | ||||||
15 | jointly against the employer and the insurance carrier.
| ||||||
16 | (h) It shall be unlawful for any employer, insurance | ||||||
17 | company or
service or adjustment company to interfere with, | ||||||
18 | restrain or coerce an
employee in any manner whatsoever in the | ||||||
19 | exercise of the rights or
remedies granted to him or her by | ||||||
20 | this Act or to discriminate, attempt to
discriminate, or | ||||||
21 | threaten to discriminate against an employee in any way
because | ||||||
22 | of his or her exercise of the rights or remedies granted to
him | ||||||
23 | or her by this Act.
| ||||||
24 | It shall be unlawful for any employer, individually or | ||||||
25 | through any
insurance company or service or adjustment company, | ||||||
26 | to discharge or to
threaten to discharge, or to refuse to |
| |||||||
| |||||||
1 | rehire or recall to active
service in a suitable capacity an | ||||||
2 | employee because of the exercise of
his or her rights or | ||||||
3 | remedies granted to him or her by this Act.
| ||||||
4 | (i) If an employer elects to obtain a life insurance policy | ||||||
5 | on his
employees, he may also elect to apply such benefits in | ||||||
6 | satisfaction of all
or a portion of the death benefits payable | ||||||
7 | under this Act, in which case,
the employer's compensation | ||||||
8 | premium shall be reduced accordingly.
| ||||||
9 | (j) Within 45 days of receipt of an initial application or | ||||||
10 | application
to renew self-insurance privileges the | ||||||
11 | Self-Insurers Advisory Board shall
review and submit for | ||||||
12 | approval by the Chairman of the Commission
recommendations of | ||||||
13 | disposition of all initial applications to self-insure
and all | ||||||
14 | applications to renew self-insurance privileges filed by | ||||||
15 | private
self-insurers pursuant to the provisions of this | ||||||
16 | Section and Section 4a-9
of this Act. Each private self-insurer | ||||||
17 | shall submit with its initial and
renewal applications the | ||||||
18 | application fee required by Section 4a-4 of this Act.
| ||||||
19 | The Chairman of the Commission shall promptly act upon all | ||||||
20 | initial
applications and applications for renewal in full | ||||||
21 | accordance with the
recommendations of the Board or, should the | ||||||
22 | Chairman disagree with any
recommendation of disposition of the | ||||||
23 | Self-Insurer's Advisory Board, he
shall within 30 days of | ||||||
24 | receipt of such recommendation provide to the Board
in writing | ||||||
25 | the reasons supporting his decision. The Chairman shall also
| ||||||
26 | promptly notify the employer of his decision within 15 days of |
| |||||||
| |||||||
1 | receipt of
the recommendation of the Board.
| ||||||
2 | If an employer is denied a renewal of self-insurance | ||||||
3 | privileges pursuant
to application it shall retain said | ||||||
4 | privilege for 120 days after receipt of
a notice of | ||||||
5 | cancellation of the privilege from the Chairman of the | ||||||
6 | Commission.
| ||||||
7 | All orders made by the Chairman under this Section shall be | ||||||
8 | subject to
review by the courts, such review to be taken in the | ||||||
9 | same manner and within
the same time as provided by subsection | ||||||
10 | (f) of Section 19 of this Act for
review of awards and | ||||||
11 | decisions of the Commission, upon the party seeking
the review | ||||||
12 | filing with the clerk of the court to which such review is | ||||||
13 | taken
a bond in an amount to be fixed and approved by the court | ||||||
14 | to which the
review is taken, conditioned upon the payment of | ||||||
15 | all compensation awarded
against the person taking such review | ||||||
16 | pending a decision thereof and
further conditioned upon such | ||||||
17 | other obligations as the court may impose.
Upon the review the | ||||||
18 | Circuit Court shall have power to review all questions
of fact | ||||||
19 | as well as of law.
| ||||||
20 | (Source: P.A. 97-18, eff. 6-28-11.)
| ||||||
21 | (820 ILCS 305/8) (from Ch. 48, par. 138.8)
| ||||||
22 | Sec. 8. The amount of compensation which shall be paid to | ||||||
23 | the
employee for an accidental injury not resulting in death | ||||||
24 | is:
| ||||||
25 | (a) The employer shall provide and pay the negotiated rate, |
| |||||||
| |||||||
1 | if applicable, or the lesser of the health care provider's | ||||||
2 | actual charges or according to a fee schedule, subject to | ||||||
3 | Section 8.2, in effect at the time the service was rendered for | ||||||
4 | all the necessary first
aid, medical and surgical services, and | ||||||
5 | all necessary medical, surgical
and hospital services | ||||||
6 | thereafter incurred, limited, however, to that
which is | ||||||
7 | reasonably required to cure or relieve from the effects of the
| ||||||
8 | accidental injury, even if a health care provider sells, | ||||||
9 | transfers, or otherwise assigns an account receivable for | ||||||
10 | procedures, treatments, or services covered under this Act. If | ||||||
11 | the employer does not dispute payment of first aid, medical, | ||||||
12 | surgical,
and hospital services, the employer shall make such | ||||||
13 | payment to the provider on behalf of the employee. The employer | ||||||
14 | shall also pay for treatment,
instruction and training | ||||||
15 | necessary for the physical, mental and
vocational | ||||||
16 | rehabilitation of the employee, including all maintenance
| ||||||
17 | costs and expenses incidental thereto. If as a result of the | ||||||
18 | injury the
employee is unable to be self-sufficient the | ||||||
19 | employer shall further pay
for such maintenance or | ||||||
20 | institutional care as shall be required.
| ||||||
21 | The employee may at any time elect to secure his own | ||||||
22 | physician,
surgeon and hospital services at the employer's | ||||||
23 | expense, or, | ||||||
24 | Upon agreement between the employer and the employees, or | ||||||
25 | the employees'
exclusive representative, and subject to the | ||||||
26 | approval of the Illinois Workers' Compensation
Commission, the |
| |||||||
| |||||||
1 | employer shall maintain a list of physicians, to be
known as a | ||||||
2 | Panel of Physicians, who are accessible to the employees.
The | ||||||
3 | employer shall post this list in a place or places easily | ||||||
4 | accessible
to his employees. The employee shall have the right | ||||||
5 | to make an
alternative choice of physician from such Panel if | ||||||
6 | he is not satisfied
with the physician first selected. If, due | ||||||
7 | to the nature of the injury
or its occurrence away from the | ||||||
8 | employer's place of business, the
employee is unable to make a | ||||||
9 | selection from the Panel, the selection
process from the Panel | ||||||
10 | shall not apply. The physician selected from the
Panel may | ||||||
11 | arrange for any consultation, referral or other specialized
| ||||||
12 | medical services outside the Panel at the employer's expense. | ||||||
13 | Provided
that, in the event the Commission shall find that a | ||||||
14 | doctor selected by
the employee is rendering improper or | ||||||
15 | inadequate care, the Commission
may order the employee to | ||||||
16 | select another doctor certified or qualified
in the medical | ||||||
17 | field for which treatment is required. If the employee
refuses | ||||||
18 | to make such change the Commission may relieve the employer of
| ||||||
19 | his obligation to pay the doctor's charges from the date of | ||||||
20 | refusal to
the date of compliance.
| ||||||
21 | Any vocational rehabilitation counselors who provide | ||||||
22 | service under this Act shall have
appropriate certifications | ||||||
23 | which designate the counselor as qualified to render
opinions | ||||||
24 | relating to vocational rehabilitation. Vocational | ||||||
25 | rehabilitation
may include, but is not limited to, counseling | ||||||
26 | for job searches, supervising
a job search program, and |
| |||||||
| |||||||
1 | vocational retraining including education at an
accredited | ||||||
2 | learning institution. The employee or employer may petition to | ||||||
3 | the Commission to decide disputes relating to vocational | ||||||
4 | rehabilitation and the Commission shall resolve any such | ||||||
5 | dispute, including payment of the vocational rehabilitation | ||||||
6 | program by the employer. | ||||||
7 | The maintenance benefit shall not be less than the | ||||||
8 | temporary total disability
rate determined for the employee. In | ||||||
9 | addition, maintenance shall include costs
and expenses | ||||||
10 | incidental to the vocational rehabilitation program. | ||||||
11 | When the employee is working light duty on a part-time | ||||||
12 | basis or full-time
basis
and earns less than he or she would be | ||||||
13 | earning if employed in the full capacity
of the job or jobs, | ||||||
14 | then the employee shall be entitled to temporary partial | ||||||
15 | disability benefits. Temporary partial disability benefits | ||||||
16 | shall be
equal to two-thirds of
the difference between the | ||||||
17 | average amount that the employee would be able to
earn in the | ||||||
18 | full performance of his or her duties in the occupation in | ||||||
19 | which he
or she was engaged at the time of accident and the | ||||||
20 | gross amount which he or she
is
earning in the modified job | ||||||
21 | provided to the employee by the employer or in any other job | ||||||
22 | that the employee is working. | ||||||
23 | Every hospital, physician, surgeon or other person | ||||||
24 | rendering
treatment or services in accordance with the | ||||||
25 | provisions of this Section
shall upon written request furnish | ||||||
26 | full and complete reports thereof to,
and permit their records |
| |||||||
| |||||||
1 | to be copied by, the employer, the employee or
his dependents, | ||||||
2 | as the case may be, or any other party to any proceeding
for | ||||||
3 | compensation before the Commission, or their attorneys.
| ||||||
4 | Notwithstanding the foregoing, the employer's liability to | ||||||
5 | pay for such
medical services selected by the employee shall be | ||||||
6 | limited to:
| ||||||
7 | (1) all first aid and emergency treatment; plus
| ||||||
8 | (2) all medical, surgical and hospital services | ||||||
9 | provided by the
physician, surgeon or hospital initially | ||||||
10 | chosen by the employee or by any
other physician, | ||||||
11 | consultant, expert, institution or other provider of
| ||||||
12 | services recommended by said initial service provider or | ||||||
13 | any subsequent
provider of medical services in the chain of | ||||||
14 | referrals from said
initial service provider; plus
| ||||||
15 |
(3) all medical, surgical and hospital services | ||||||
16 | provided by any second
physician, surgeon or hospital | ||||||
17 | subsequently chosen by the employee or by
any other | ||||||
18 | physician, consultant, expert, institution or other | ||||||
19 | provider of
services recommended by said second service | ||||||
20 | provider or any subsequent provider
of medical services in | ||||||
21 | the chain of referrals
from said second service provider. | ||||||
22 | Thereafter the employer shall select
and pay for all | ||||||
23 | necessary medical, surgical and hospital treatment and the
| ||||||
24 | employee may not select a provider of medical services at | ||||||
25 | the employer's
expense unless the employer agrees to such | ||||||
26 | selection. At any time the employee
may obtain any medical |
| |||||||
| |||||||
1 | treatment he desires at his own expense. This paragraph
| ||||||
2 | shall not affect the duty to pay for rehabilitation | ||||||
3 | referred to above.
| ||||||
4 | (4) The following shall apply for injuries occurring on | ||||||
5 | or after June 28, 2011 (the effective date of Public Act | ||||||
6 | 97-18) and only when an employer has an approved preferred | ||||||
7 | provider program pursuant to Section 8.1a on the date the | ||||||
8 | employee sustained his or her accidental injuries: | ||||||
9 | (A) The employer shall, in writing, on a form | ||||||
10 | promulgated by the Commission, inform the employee of | ||||||
11 | the preferred provider program; | ||||||
12 | (B) Subsequent to the report of an injury by an | ||||||
13 | employee, the employee may choose in writing at any | ||||||
14 | time to decline the preferred provider program, in | ||||||
15 | which case that would constitute one of the two choices | ||||||
16 | of medical providers to which the employee is entitled | ||||||
17 | under subsection (a)(2) or (a)(3); and | ||||||
18 | (C) Prior to the report of an injury by an | ||||||
19 | employee, when an employee chooses non-emergency | ||||||
20 | treatment from a provider not within the preferred | ||||||
21 | provider program, that would constitute the employee's | ||||||
22 | one choice of medical providers to which the employee | ||||||
23 | is entitled under subsection (a)(2) or (a)(3). | ||||||
24 | When an employer and employee so agree in writing, nothing | ||||||
25 | in this
Act prevents an employee whose injury or disability has | ||||||
26 | been established
under this Act, from relying in good faith, on |
| |||||||
| |||||||
1 | treatment by prayer or
spiritual means alone, in accordance | ||||||
2 | with the tenets and practice of a
recognized church or | ||||||
3 | religious denomination, by a duly accredited
practitioner | ||||||
4 | thereof, and having nursing services appropriate therewith,
| ||||||
5 | without suffering loss or diminution of the compensation | ||||||
6 | benefits under
this Act. However, the employee shall submit to | ||||||
7 | all physical
examinations required by this Act. The cost of | ||||||
8 | such treatment and
nursing care shall be paid by the employee | ||||||
9 | unless the employer agrees to
make such payment.
| ||||||
10 | Where the accidental injury results in the amputation of an | ||||||
11 | arm,
hand, leg or foot, or the enucleation of an eye, or the | ||||||
12 | loss of any of
the natural teeth, the employer shall furnish an | ||||||
13 | artificial of any such
members lost or damaged in accidental | ||||||
14 | injury arising out of and in the
course of employment, and | ||||||
15 | shall also furnish the necessary braces in all
proper and | ||||||
16 | necessary cases. In cases of the loss of a member or members
by | ||||||
17 | amputation, the employer shall, whenever necessary, maintain | ||||||
18 | in good
repair, refit or replace the artificial limbs during | ||||||
19 | the lifetime of the
employee. Where the accidental injury | ||||||
20 | accompanied by physical injury
results in damage to a denture, | ||||||
21 | eye glasses or contact eye lenses, or
where the accidental | ||||||
22 | injury results in damage to an artificial member,
the employer | ||||||
23 | shall replace or repair such denture, glasses, lenses, or
| ||||||
24 | artificial member.
| ||||||
25 | The furnishing by the employer of any such services or | ||||||
26 | appliances is
not an admission of liability on the part of the |
| |||||||
| |||||||
1 | employer to pay
compensation.
| ||||||
2 | The furnishing of any such services or appliances or the | ||||||
3 | servicing
thereof by the employer is not the payment of | ||||||
4 | compensation.
| ||||||
5 | (b) If the period of temporary total incapacity for work | ||||||
6 | lasts more
than 3 working days, weekly compensation as | ||||||
7 | hereinafter provided shall
be paid beginning on the 4th day of | ||||||
8 | such temporary total incapacity and
continuing as long as the | ||||||
9 | total temporary incapacity lasts. In cases
where the temporary | ||||||
10 | total incapacity for work continues for a period of
14 days or | ||||||
11 | more from the day of the accident compensation shall commence
| ||||||
12 | on the day after the accident.
| ||||||
13 | 1. The compensation rate for temporary total | ||||||
14 | incapacity under this
paragraph (b) of this Section shall | ||||||
15 | be equal to 66 2/3% of the
employee's average weekly wage | ||||||
16 | computed in accordance with Section 10,
provided that it | ||||||
17 | shall be not less than 66 2/3% of the sum of the Federal | ||||||
18 | minimum wage under the Fair Labor
Standards Act, or the | ||||||
19 | Illinois minimum wage under the Minimum Wage Law,
whichever | ||||||
20 | is more, multiplied by 40 hours. This percentage rate shall | ||||||
21 | be
increased by 10% for each spouse and child, not to | ||||||
22 | exceed 100% of the total
minimum wage calculation,
| ||||||
23 | nor exceed the employee's average weekly wage computed in | ||||||
24 | accordance
with the provisions of Section 10, whichever is | ||||||
25 | less.
| ||||||
26 | 2. The compensation rate in all cases other than for |
| |||||||
| |||||||
1 | temporary total
disability under this paragraph (b), and | ||||||
2 | other than for serious and
permanent disfigurement under | ||||||
3 | paragraph (c) and other than for permanent
partial | ||||||
4 | disability under subparagraph (2) of paragraph (d) or under
| ||||||
5 | paragraph (e), of this Section shall be equal to 66
2/3% of | ||||||
6 | the employee's average weekly wage computed in accordance | ||||||
7 | with
the provisions of Section 10, provided that it shall | ||||||
8 | be not less than
66 2/3% of the sum of the Federal minimum | ||||||
9 | wage under the Fair Labor Standards Act, or the Illinois | ||||||
10 | minimum wage under the Minimum Wage Law, whichever is more, | ||||||
11 | multiplied by 40 hours. This percentage rate shall be | ||||||
12 | increased by 10% for each spouse and child, not to exceed | ||||||
13 | 100% of the total minimum wage calculation,
| ||||||
14 | nor exceed the employee's average weekly wage computed in | ||||||
15 | accordance
with the provisions of Section 10, whichever is | ||||||
16 | less.
| ||||||
17 | 2.1. The compensation rate in all cases of serious and | ||||||
18 | permanent
disfigurement under paragraph (c) and of | ||||||
19 | permanent partial disability
under subparagraph (2) of | ||||||
20 | paragraph (d) or under paragraph (e) of this
Section shall | ||||||
21 | be equal to
60% of the employee's average
weekly wage | ||||||
22 | computed in accordance with
the provisions of Section 10, | ||||||
23 | provided that it shall be not less than
66 2/3% of the sum | ||||||
24 | of the Federal minimum wage under the Fair Labor Standards | ||||||
25 | Act, or the Illinois minimum wage under the Minimum Wage | ||||||
26 | Law, whichever is more, multiplied by 40 hours. This |
| |||||||
| |||||||
1 | percentage rate shall be increased by 10% for each spouse | ||||||
2 | and child, not to exceed 100% of the total minimum wage | ||||||
3 | calculation,
| ||||||
4 | nor exceed the employee's average weekly wage computed in | ||||||
5 | accordance
with the provisions of Section 10, whichever is | ||||||
6 | less.
| ||||||
7 | 3. As used in this Section the term "child" means a | ||||||
8 | child of the
employee including any child legally adopted | ||||||
9 | before the accident or whom
at the time of the accident the | ||||||
10 | employee was under legal obligation to
support or to whom | ||||||
11 | the employee stood in loco parentis, and who at the
time of | ||||||
12 | the accident was under 18 years of age and not emancipated. | ||||||
13 | The
term "children" means the plural of "child".
| ||||||
14 | 4. All weekly compensation rates provided under | ||||||
15 | subparagraphs 1,
2 and 2.1 of this paragraph (b) of this | ||||||
16 | Section shall be subject to the
following limitations:
| ||||||
17 | The maximum weekly compensation rate from July 1, 1975, | ||||||
18 | except as
hereinafter provided, shall be 100% of the | ||||||
19 | State's average weekly wage in
covered industries under the | ||||||
20 | Unemployment Insurance Act, that being the
wage that most | ||||||
21 | closely approximates the State's average weekly wage.
| ||||||
22 | The maximum weekly compensation rate, for the period | ||||||
23 | July 1, 1984,
through June 30, 1987, except as hereinafter | ||||||
24 | provided, shall be $293.61.
Effective July 1, 1987 and on | ||||||
25 | July 1 of each year thereafter the maximum
weekly | ||||||
26 | compensation rate, except as hereinafter provided, shall |
| |||||||
| |||||||
1 | be
determined as follows: if during the preceding 12 month | ||||||
2 | period there shall
have been an increase in the State's | ||||||
3 | average weekly wage in covered
industries under the | ||||||
4 | Unemployment Insurance Act, the weekly compensation
rate | ||||||
5 | shall be proportionately increased by the same percentage | ||||||
6 | as the
percentage of increase in the State's average weekly | ||||||
7 | wage in covered
industries under the Unemployment | ||||||
8 | Insurance Act during such period.
| ||||||
9 | The maximum weekly compensation rate, for the period | ||||||
10 | January 1, 1981
through December 31, 1983, except as | ||||||
11 | hereinafter provided, shall be 100% of
the State's average | ||||||
12 | weekly wage in covered industries under the
Unemployment | ||||||
13 | Insurance Act in effect on January 1, 1981. Effective | ||||||
14 | January
1, 1984 and on January 1, of each year thereafter | ||||||
15 | the maximum weekly
compensation rate, except as | ||||||
16 | hereinafter provided, shall be determined as
follows: if | ||||||
17 | during the preceding 12 month period there shall have been | ||||||
18 | an
increase in the State's average weekly wage in covered | ||||||
19 | industries under the
Unemployment Insurance Act, the | ||||||
20 | weekly compensation rate shall be
proportionately | ||||||
21 | increased by the same percentage as the percentage of
| ||||||
22 | increase in the State's average weekly wage in covered | ||||||
23 | industries under the
Unemployment Insurance Act during | ||||||
24 | such period.
| ||||||
25 | From July 1, 1977 and thereafter such maximum weekly | ||||||
26 | compensation
rate in death cases under Section 7, and |
| |||||||
| |||||||
1 | permanent total disability
cases under paragraph (f) or | ||||||
2 | subparagraph 18 of paragraph (3) of this
Section and for | ||||||
3 | temporary total disability under paragraph (b) of this
| ||||||
4 | Section and for amputation of a member or enucleation of an | ||||||
5 | eye under
paragraph (e) of this Section shall be increased | ||||||
6 | to 133-1/3% of the
State's average weekly wage in covered | ||||||
7 | industries under the
Unemployment Insurance Act.
| ||||||
8 | For injuries occurring on or after February 1, 2006, | ||||||
9 | the maximum weekly benefit under paragraph (d)1 of this | ||||||
10 | Section shall be 100% of the State's average weekly wage in | ||||||
11 | covered industries under the Unemployment Insurance Act.
| ||||||
12 | 4.1. Any provision herein to the contrary | ||||||
13 | notwithstanding, the
weekly compensation rate for | ||||||
14 | compensation payments under subparagraph 18
of paragraph | ||||||
15 | (e) of this Section and under paragraph (f) of this
Section | ||||||
16 | and under paragraph (a) of Section 7 and for amputation of | ||||||
17 | a member or enucleation of an eye under paragraph (e) of | ||||||
18 | this Section, shall in no event be less
than 50% of the | ||||||
19 | State's average weekly wage in covered industries under
the | ||||||
20 | Unemployment Insurance Act.
| ||||||
21 | 4.2. Any provision to the contrary notwithstanding, | ||||||
22 | the total
compensation payable under Section 7 shall not | ||||||
23 | exceed the greater of $500,000
or 25
years.
| ||||||
24 | 5. For the purpose of this Section this State's average | ||||||
25 | weekly wage
in covered industries under the Unemployment | ||||||
26 | Insurance Act on
July 1, 1975 is hereby fixed at $228.16 |
| |||||||
| |||||||
1 | per
week and the computation of compensation rates shall be | ||||||
2 | based on the
aforesaid average weekly wage until modified | ||||||
3 | as hereinafter provided.
| ||||||
4 | 6. The Department of Employment Security of the State | ||||||
5 | shall
on or before the first day of December, 1977, and on | ||||||
6 | or before the first
day of June, 1978, and on the first day | ||||||
7 | of each December and June of each
year thereafter, publish | ||||||
8 | the State's average weekly wage in covered
industries under | ||||||
9 | the Unemployment Insurance Act and the Illinois Workers' | ||||||
10 | Compensation
Commission shall on the 15th day of January, | ||||||
11 | 1978 and on the 15th day of
July, 1978 and on the 15th day | ||||||
12 | of each January and July of each year
thereafter, post and | ||||||
13 | publish the State's average weekly wage in covered
| ||||||
14 | industries under the Unemployment Insurance Act as last | ||||||
15 | determined and
published by the Department of Employment | ||||||
16 | Security. The amount when so
posted and published shall be | ||||||
17 | conclusive and shall be applicable as the
basis of | ||||||
18 | computation of compensation rates until the next posting | ||||||
19 | and
publication as aforesaid.
| ||||||
20 | 7. The payment of compensation by an employer or his | ||||||
21 | insurance
carrier to an injured employee shall not | ||||||
22 | constitute an admission of the
employer's liability to pay | ||||||
23 | compensation.
| ||||||
24 | (c) For any serious and permanent disfigurement to the | ||||||
25 | hand, head,
face, neck, arm, leg below the knee or the chest | ||||||
26 | above the axillary
line, the employee is entitled to |
| |||||||
| |||||||
1 | compensation for such disfigurement,
the amount determined by | ||||||
2 | agreement at any time or by arbitration under
this Act, at a | ||||||
3 | hearing not less than 6 months after the date of the
accidental | ||||||
4 | injury, which amount shall not exceed 150 weeks (if the | ||||||
5 | accidental injury occurs on or after the effective date of this | ||||||
6 | amendatory Act of the 94th General Assembly
but before February
| ||||||
7 | 1, 2006) or 162
weeks (if the accidental injury occurs on or | ||||||
8 | after February
1, 2006) at the
applicable rate provided in | ||||||
9 | subparagraph 2.1 of paragraph (b) of this Section.
| ||||||
10 | No compensation is payable under this paragraph where | ||||||
11 | compensation is
payable under paragraphs (d), (e) or (f) of | ||||||
12 | this Section.
| ||||||
13 | A duly appointed member of a fire department in a city, the | ||||||
14 | population of
which exceeds 500,000 according to the last | ||||||
15 | federal or State census, is
eligible for compensation under | ||||||
16 | this paragraph only where such serious and
permanent | ||||||
17 | disfigurement results from burns.
| ||||||
18 | (d) 1. If, after the accidental injury has been sustained, | ||||||
19 | the
employee as a result thereof becomes partially | ||||||
20 | incapacitated from
pursuing his usual and customary line of | ||||||
21 | employment, he shall, except in
cases compensated under the | ||||||
22 | specific schedule set forth in paragraph (e)
of this Section, | ||||||
23 | receive compensation for the duration of his
disability, | ||||||
24 | subject to the limitations as to maximum amounts fixed in
| ||||||
25 | paragraph (b) of this Section, equal to 66-2/3% of the | ||||||
26 | difference
between the average amount which he would be able to |
| |||||||
| |||||||
1 | earn in the full
performance of his duties in the occupation in | ||||||
2 | which he was engaged at
the time of the accident and the | ||||||
3 | average amount which he is earning or
is able to earn in some | ||||||
4 | suitable employment or business after the accident. For | ||||||
5 | accidental injuries that occur on or after September 1, 2011, | ||||||
6 | an award for wage differential under this subsection shall be | ||||||
7 | effective only until the employee reaches the age of 67 or 5 | ||||||
8 | years from the date the award becomes final, whichever is | ||||||
9 | later.
| ||||||
10 | 2. If, as a result of the accident, the employee sustains | ||||||
11 | serious
and permanent injuries not covered by paragraphs (c) | ||||||
12 | and (e) of this
Section or having sustained injuries covered by | ||||||
13 | the aforesaid
paragraphs (c) and (e), he shall have sustained | ||||||
14 | in addition thereto
other injuries which injuries do not | ||||||
15 | incapacitate him from pursuing the
duties of his employment but | ||||||
16 | which would disable him from pursuing other
suitable | ||||||
17 | occupations, or which have otherwise resulted in physical
| ||||||
18 | impairment; or if such injuries partially incapacitate him from | ||||||
19 | pursuing
the duties of his usual and customary line of | ||||||
20 | employment but do not
result in an impairment of earning | ||||||
21 | capacity, or having resulted in an
impairment of earning | ||||||
22 | capacity, the employee elects to waive his right
to recover | ||||||
23 | under the foregoing subparagraph 1 of paragraph (d) of this
| ||||||
24 | Section then in any of the foregoing events, he shall receive | ||||||
25 | in
addition to compensation for temporary total disability | ||||||
26 | under paragraph
(b) of this Section, compensation at the rate |
| |||||||
| |||||||
1 | provided in subparagraph 2.1
of paragraph (b) of this Section | ||||||
2 | for that percentage of 500 weeks that
the partial disability | ||||||
3 | resulting from the injuries covered by this
paragraph bears to | ||||||
4 | total disability. If the employee shall have
sustained a | ||||||
5 | fracture of one or more vertebra or fracture of the skull,
the | ||||||
6 | amount of compensation allowed under this Section shall be not | ||||||
7 | less
than 6 weeks for a fractured skull and 6 weeks for each | ||||||
8 | fractured
vertebra, and in the event the employee shall have | ||||||
9 | sustained a fracture
of any of the following facial bones: | ||||||
10 | nasal, lachrymal, vomer, zygoma,
maxilla, palatine or | ||||||
11 | mandible, the amount of compensation allowed under
this Section | ||||||
12 | shall be not less than 2 weeks for each such fractured
bone, | ||||||
13 | and for a fracture of each transverse process not less than 3
| ||||||
14 | weeks. In the event such injuries shall result in the loss of a | ||||||
15 | kidney,
spleen or lung, the amount of compensation allowed | ||||||
16 | under this Section
shall be not less than 10 weeks for each | ||||||
17 | such organ. Compensation
awarded under this subparagraph 2 | ||||||
18 | shall not take into consideration
injuries covered under | ||||||
19 | paragraphs (c) and (e) of this Section and the
compensation | ||||||
20 | provided in this paragraph shall not affect the employee's
| ||||||
21 | right to compensation payable under paragraphs (b), (c) and (e) | ||||||
22 | of this
Section for the disabilities therein covered.
| ||||||
23 | In computing the compensation to be paid to any employee | ||||||
24 | who, before the accident for which he or she claims | ||||||
25 | compensation, had before that time sustained an injury | ||||||
26 | resulting in an award or settlement for permanency given under |
| |||||||
| |||||||
1 | paragraph 2 of paragraph (d) of this Section, such award shall | ||||||
2 | be deducted from any award made for the subsequent injury | ||||||
3 | resulting in an award or settlement for permanency given under | ||||||
4 | paragraph 2 of paragraph (d) of this Section. | ||||||
5 | (e) For accidental injuries in the following schedule, the | ||||||
6 | employee
shall receive compensation for the period of temporary | ||||||
7 | total incapacity
for work resulting from such accidental | ||||||
8 | injury, under subparagraph 1 of
paragraph (b) of this Section, | ||||||
9 | and shall receive in addition thereto
compensation for a | ||||||
10 | further period for the specific loss herein
mentioned, but | ||||||
11 | shall not receive any compensation under any other
provisions | ||||||
12 | of this Act. The following listed amounts apply to either
the | ||||||
13 | loss of or the permanent and complete loss of use of the member
| ||||||
14 | specified, such compensation for the length of time as follows:
| ||||||
15 | 1. Thumb- | ||||||
16 | 70 weeks if the accidental injury occurs on or | ||||||
17 | after the effective date of this amendatory Act of the | ||||||
18 | 94th General Assembly
but before February
1, 2006.
| ||||||
19 | 76
weeks if the accidental injury occurs on or | ||||||
20 | after February
1, 2006.
| ||||||
21 | 2. First, or index finger- | ||||||
22 | 40 weeks if the accidental injury occurs on or | ||||||
23 | after the effective date of this amendatory Act of the | ||||||
24 | 94th General Assembly
but before February
1, 2006.
| ||||||
25 | 43
weeks if the accidental injury occurs on or | ||||||
26 | after February
1, 2006.
|
| |||||||
| |||||||
1 | 3. Second, or middle finger- | ||||||
2 | 35 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 | 38
weeks if the accidental injury occurs on or | ||||||
6 | after February
1, 2006.
| ||||||
7 | 4. Third, or ring finger- | ||||||
8 | 25 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 | 27
weeks if the accidental injury occurs on or | ||||||
12 | after February
1, 2006.
| ||||||
13 | 5. Fourth, or little finger- | ||||||
14 | 20 weeks if the accidental injury occurs on or | ||||||
15 | after the effective date of this amendatory Act of the | ||||||
16 | 94th General Assembly
but before February
1, 2006.
| ||||||
17 | 22
weeks if the accidental injury occurs on or | ||||||
18 | after February
1, 2006.
| ||||||
19 | 6. Great toe- | ||||||
20 | 35 weeks if the accidental injury occurs on or | ||||||
21 | after the effective date of this amendatory Act of the | ||||||
22 | 94th General Assembly
but before February
1, 2006.
| ||||||
23 | 38
weeks if the accidental injury occurs on or | ||||||
24 | after February
1, 2006.
| ||||||
25 | 7. Each toe other than great toe- | ||||||
26 | 12 weeks if the accidental injury occurs on or |
| |||||||
| |||||||
1 | after the effective date of this amendatory Act of the | ||||||
2 | 94th General Assembly
but before February
1, 2006.
| ||||||
3 | 13
weeks if the accidental injury occurs on or | ||||||
4 | after February
1, 2006.
| ||||||
5 | 8. The loss of the first or distal phalanx of the thumb | ||||||
6 | or of any
finger or toe shall be considered to be equal to | ||||||
7 | the loss of one-half of
such thumb, finger or toe and the | ||||||
8 | compensation payable shall be one-half
of the amount above | ||||||
9 | specified. The loss of more than one phalanx shall
be | ||||||
10 | considered as the loss of the entire thumb, finger or toe. | ||||||
11 | In no
case shall the amount received for more than one | ||||||
12 | finger exceed the
amount provided in this schedule for the | ||||||
13 | loss of a hand.
| ||||||
14 | 9. Hand- | ||||||
15 | 190 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 | 205
weeks if the accidental injury occurs on or | ||||||
19 | after February
1, 2006. | ||||||
20 | 190 weeks if the accidental injury occurs on or | ||||||
21 | after June 28, 2011 (the effective date of Public Act | ||||||
22 | 97-18) and if the accidental injury involves carpal | ||||||
23 | tunnel syndrome due to repetitive or cumulative | ||||||
24 | trauma, in which case the permanent partial disability | ||||||
25 | shall not exceed 15% loss of use of the hand, except | ||||||
26 | for cause shown by clear and convincing evidence and in |
| |||||||
| |||||||
1 | which case the award shall not exceed 30% loss of use | ||||||
2 | of the hand. | ||||||
3 | The loss of 2 or more digits, or one or more
phalanges | ||||||
4 | of 2 or more digits, of a hand may be compensated on the | ||||||
5 | basis
of partial loss of use of a hand, provided, further, | ||||||
6 | that the loss of 4
digits, or the loss of use of 4 digits, | ||||||
7 | in the same hand shall
constitute the complete loss of a | ||||||
8 | hand.
| ||||||
9 | 10. Arm- | ||||||
10 | 235 weeks if the accidental injury occurs on or | ||||||
11 | after the effective date of this amendatory Act of the | ||||||
12 | 94th General Assembly
but before February
1, 2006.
| ||||||
13 | 253
weeks if the accidental injury occurs on or | ||||||
14 | after February
1, 2006. | ||||||
15 | Where an accidental injury results in the
amputation of | ||||||
16 | an arm below the elbow, such injury shall be compensated
as | ||||||
17 | a loss of an arm. Where an accidental injury results in the
| ||||||
18 | amputation of an arm above the elbow, compensation for an | ||||||
19 | additional 15 weeks (if the accidental injury occurs on or | ||||||
20 | after the effective date of this amendatory Act of the 94th | ||||||
21 | General Assembly
but before February
1, 2006) or an | ||||||
22 | additional 17
weeks (if the accidental injury occurs on or | ||||||
23 | after February
1, 2006) shall be paid, except where the | ||||||
24 | accidental injury results in the
amputation of an arm at | ||||||
25 | the shoulder joint, or so close to shoulder
joint that an | ||||||
26 | artificial arm cannot be used, or results in the
|
| |||||||
| |||||||
1 | disarticulation of an arm at the shoulder joint, in which | ||||||
2 | case
compensation for an additional 65 weeks (if the | ||||||
3 | accidental injury occurs on or after the effective date of | ||||||
4 | this amendatory Act of the 94th General Assembly
but before | ||||||
5 | February
1, 2006) or an additional 70
weeks (if the | ||||||
6 | accidental injury occurs on or after February
1, 2006)
| ||||||
7 | shall be paid.
| ||||||
8 | 11. Foot- | ||||||
9 | 155 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 | 167
weeks if the accidental injury occurs on or | ||||||
13 | after February
1, 2006.
| ||||||
14 | 12. Leg- | ||||||
15 | 200 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 | 215
weeks if the accidental injury occurs on or | ||||||
19 | after February
1, 2006. | ||||||
20 | Where an accidental injury results in the
amputation of | ||||||
21 | a leg below the knee, such injury shall be compensated as
| ||||||
22 | loss of a leg. Where an accidental injury results in the | ||||||
23 | amputation of a
leg above the knee, compensation for an | ||||||
24 | additional 25 weeks (if the accidental injury occurs on or | ||||||
25 | after the effective date of this amendatory Act of the 94th | ||||||
26 | General Assembly
but before February
1, 2006) or an |
| |||||||
| |||||||
1 | additional 27
weeks (if the accidental injury occurs on or | ||||||
2 | after February
1, 2006) shall be
paid, except where the | ||||||
3 | accidental injury results in the amputation of a
leg at the | ||||||
4 | hip joint, or so close to the hip joint that an artificial
| ||||||
5 | leg cannot be used, or results in the disarticulation of a | ||||||
6 | leg at the
hip joint, in which case compensation for an | ||||||
7 | additional 75 weeks (if the accidental injury occurs on or | ||||||
8 | after the effective date of this amendatory Act of the 94th | ||||||
9 | General Assembly
but before February
1, 2006) or an | ||||||
10 | additional 81
weeks (if the accidental injury occurs on or | ||||||
11 | after February
1, 2006) shall
be paid.
| ||||||
12 | 13. Eye- | ||||||
13 | 150 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 | 162
weeks if the accidental injury occurs on or | ||||||
17 | after February
1, 2006. | ||||||
18 | Where an accidental injury results in the
enucleation | ||||||
19 | of an eye, compensation for an additional 10 weeks (if the | ||||||
20 | accidental injury occurs on or after the effective date of | ||||||
21 | this amendatory Act of the 94th General Assembly
but before | ||||||
22 | February
1, 2006) or an additional 11
weeks (if the | ||||||
23 | accidental injury occurs on or after February
1, 2006)
| ||||||
24 | shall be
paid.
| ||||||
25 | 14. Loss of hearing of one ear- | ||||||
26 | 50 weeks if the accidental injury occurs on or |
| |||||||
| |||||||
1 | after the effective date of this amendatory Act of the | ||||||
2 | 94th General Assembly
but before February
1, 2006.
| ||||||
3 | 54
weeks if the accidental injury occurs on or | ||||||
4 | after February
1, 2006.
| ||||||
5 | Total and permanent loss of
hearing of both ears- | ||||||
6 | 200 weeks if the accidental injury occurs on or | ||||||
7 | after the effective date of this amendatory Act of the | ||||||
8 | 94th General Assembly
but before February
1, 2006. | ||||||
9 | 215
weeks if the accidental injury occurs on or | ||||||
10 | after February
1, 2006.
| ||||||
11 | 15. Testicle- | ||||||
12 | 50 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 | 54
weeks if the accidental injury occurs on or | ||||||
16 | after February
1, 2006.
| ||||||
17 | Both testicles- | ||||||
18 | 150 weeks if the accidental injury occurs on or | ||||||
19 | after the effective date of this amendatory Act of the | ||||||
20 | 94th General Assembly
but before February
1, 2006.
| ||||||
21 | 162
weeks if the accidental injury occurs on or | ||||||
22 | after February
1, 2006.
| ||||||
23 | 16. For the permanent partial loss of use of a member | ||||||
24 | or sight of an
eye, or hearing of an ear, compensation | ||||||
25 | during that proportion of the
number of weeks in the | ||||||
26 | foregoing schedule provided for the loss of such
member or |
| |||||||
| |||||||
1 | sight of an eye, or hearing of an ear, which the partial | ||||||
2 | loss
of use thereof bears to the total loss of use of such | ||||||
3 | member, or sight
of eye, or hearing of an ear.
| ||||||
4 | (a) Loss of hearing for compensation purposes | ||||||
5 | shall be
confined to the frequencies of 1,000, 2,000 | ||||||
6 | and 3,000 cycles per second.
Loss of hearing ability | ||||||
7 | for frequency tones above 3,000 cycles per second
are | ||||||
8 | not to be considered as constituting disability for | ||||||
9 | hearing.
| ||||||
10 | (b) The percent of hearing loss, for purposes of | ||||||
11 | the
determination of compensation claims for | ||||||
12 | occupational deafness,
shall be calculated as the | ||||||
13 | average in decibels for the thresholds
of hearing for | ||||||
14 | the frequencies of 1,000, 2,000 and 3,000 cycles per | ||||||
15 | second.
Pure tone air conduction audiometric | ||||||
16 | instruments, approved by
nationally recognized | ||||||
17 | authorities in this field, shall be used for measuring
| ||||||
18 | hearing loss. If the losses of hearing average 30 | ||||||
19 | decibels or less in the
3 frequencies, such losses of | ||||||
20 | hearing shall not then constitute any
compensable | ||||||
21 | hearing disability. If the losses of hearing average 85
| ||||||
22 | decibels or more in the 3 frequencies, then the same | ||||||
23 | shall constitute and
be total or 100% compensable | ||||||
24 | hearing loss.
| ||||||
25 | (c) In measuring hearing impairment, the lowest | ||||||
26 | measured
losses in each of the 3 frequencies shall be |
| ||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||
1 | added together and
divided by 3 to determine the | |||||||||||||||||||||||||||||
2 | average decibel loss. For every decibel
of loss | |||||||||||||||||||||||||||||
3 | exceeding 30 decibels an allowance of 1.82% shall be | |||||||||||||||||||||||||||||
4 | made up to
the maximum of 100% which is reached at 85 | |||||||||||||||||||||||||||||
5 | decibels.
| |||||||||||||||||||||||||||||
6 | (d) If a hearing loss is established to have | |||||||||||||||||||||||||||||
7 | existed on July 1, 1975 by
audiometric testing the | |||||||||||||||||||||||||||||
8 | employer shall not be liable for the previous loss
so | |||||||||||||||||||||||||||||
9 | established nor shall he be liable for any loss for | |||||||||||||||||||||||||||||
10 | which compensation
has been paid or awarded.
| |||||||||||||||||||||||||||||
11 | (e) No consideration shall be given to the question | |||||||||||||||||||||||||||||
12 | of
whether or not the ability of an employee to | |||||||||||||||||||||||||||||
13 | understand speech
is improved by the use of a hearing | |||||||||||||||||||||||||||||
14 | aid.
| |||||||||||||||||||||||||||||
15 | (f) No claim for loss of hearing due to industrial | |||||||||||||||||||||||||||||
16 | noise
shall be brought against an employer or allowed | |||||||||||||||||||||||||||||
17 | unless the employee has
been exposed for a period of | |||||||||||||||||||||||||||||
18 | time sufficient to cause permanent impairment
to noise | |||||||||||||||||||||||||||||
19 | levels in excess of the following:
| |||||||||||||||||||||||||||||
|
| ||||||||||||||||||
| ||||||||||||||||||
| ||||||||||||||||||
5 | This subparagraph (f) shall not be applied in cases of | |||||||||||||||||
6 | hearing loss
resulting from trauma or explosion.
| |||||||||||||||||
7 | 17. In computing the compensation to be paid to any | |||||||||||||||||
8 | employee who,
before the accident for which he claims | |||||||||||||||||
9 | compensation, had before that
time sustained an injury | |||||||||||||||||
10 | resulting in any permanency award, including without | |||||||||||||||||
11 | limitation the loss by amputation or partial
loss by | |||||||||||||||||
12 | amputation of any member, including hand, arm, thumb or | |||||||||||||||||
13 | fingers,
leg, foot or any toes, the partial loss of sight | |||||||||||||||||
14 | of an eye, or an award given under paragraph (2) of | |||||||||||||||||
15 | paragraph (d) of Section 8, such award loss or partial loss | |||||||||||||||||
16 | of any such member
shall be deducted from any award made | |||||||||||||||||
17 | for the subsequent injury. For
the permanent loss of use or | |||||||||||||||||
18 | the permanent partial loss of use of any
such member or the | |||||||||||||||||
19 | partial loss of sight of an eye, for which
compensation has | |||||||||||||||||
20 | been paid, then such loss shall be taken into
consideration | |||||||||||||||||
21 | and deducted from any award for the subsequent injury.
| |||||||||||||||||
22 | 18. The specific case of loss of both hands, both arms, | |||||||||||||||||
23 | or both
feet, or both legs, or both eyes, or of any two | |||||||||||||||||
24 | thereof, or the
permanent and complete loss of the use | |||||||||||||||||
25 | thereof, constitutes total and
permanent disability, to be | |||||||||||||||||
26 | compensated according to the compensation
fixed by |
| |||||||
| |||||||
1 | paragraph (f) of this Section. These specific cases of | ||||||
2 | total
and permanent disability do not exclude other cases.
| ||||||
3 | Any employee who has previously suffered the loss or | ||||||
4 | permanent and
complete loss of the use of any of such | ||||||
5 | members, and in a subsequent
independent accident loses | ||||||
6 | another or suffers the permanent and complete
loss of the | ||||||
7 | use of any one of such members the employer for whom the
| ||||||
8 | injured employee is working at the time of the last | ||||||
9 | independent accident
is liable to pay compensation only for | ||||||
10 | the loss or permanent and
complete loss of the use of the | ||||||
11 | member occasioned by the last
independent accident.
| ||||||
12 | 19. In a case of specific loss and the subsequent death | ||||||
13 | of such
injured employee from other causes than such injury | ||||||
14 | leaving a widow,
widower, or dependents surviving before | ||||||
15 | payment or payment in full for
such injury, then the amount | ||||||
16 | due for such injury is payable to the widow
or widower and, | ||||||
17 | if there be no widow or widower, then to such
dependents, | ||||||
18 | in the proportion which such dependency bears to total
| ||||||
19 | dependency.
| ||||||
20 | Beginning July 1, 1980, and every 6 months thereafter, the | ||||||
21 | Commission
shall examine the Second Injury Fund and when, after | ||||||
22 | deducting all
advances or loans made to such Fund, the amount | ||||||
23 | therein is $500,000
then the amount required to be paid by | ||||||
24 | employers pursuant to paragraph
(f) of Section 7 shall be | ||||||
25 | reduced by one-half. When the Second Injury Fund
reaches the | ||||||
26 | sum of $600,000 then the payments shall cease entirely.
|
| |||||||
| |||||||
1 | However, when the Second Injury Fund has been reduced to | ||||||
2 | $400,000, payment
of one-half of the amounts required by | ||||||
3 | paragraph (f) of Section 7
shall be resumed, in the manner | ||||||
4 | herein provided, and when the Second Injury
Fund has been | ||||||
5 | reduced to $300,000, payment of the full amounts required by
| ||||||
6 | paragraph (f) of Section 7 shall be resumed, in the manner | ||||||
7 | herein provided.
The Commission shall make the changes in | ||||||
8 | payment effective by
general order, and the changes in payment | ||||||
9 | become immediately effective
for all cases coming before the | ||||||
10 | Commission thereafter either by
settlement agreement or final | ||||||
11 | order, irrespective of the date of the
accidental injury.
| ||||||
12 | On August 1, 1996 and on February 1 and August 1 of each | ||||||
13 | subsequent year, the Commission
shall examine the special fund | ||||||
14 | designated as the "Rate
Adjustment Fund" and when, after | ||||||
15 | deducting all advances or loans made to
said fund, the amount | ||||||
16 | therein is $4,000,000, the amount required to be
paid by | ||||||
17 | employers pursuant to paragraph (f) of Section 7 shall be
| ||||||
18 | reduced by one-half. When the Rate Adjustment Fund reaches the | ||||||
19 | sum of
$5,000,000 the payment therein shall cease entirely. | ||||||
20 | However, when said
Rate Adjustment Fund has been reduced to | ||||||
21 | $3,000,000 the amounts required by
paragraph (f) of Section 7 | ||||||
22 | shall be resumed in the manner herein provided.
| ||||||
23 | (f) In case of complete disability, which renders the | ||||||
24 | employee
wholly and permanently incapable of work, or in the | ||||||
25 | specific case of
total and permanent disability as provided in | ||||||
26 | subparagraph 18 of
paragraph (e) of this Section, compensation |
| |||||||
| |||||||
1 | shall be payable at the rate
provided in subparagraph 2 of | ||||||
2 | paragraph (b) of this Section for life.
| ||||||
3 | An employee entitled to benefits under paragraph (f) of | ||||||
4 | this Section
shall also be entitled to receive from the Rate | ||||||
5 | Adjustment
Fund provided in paragraph (f) of Section 7 of the | ||||||
6 | supplementary benefits
provided in paragraph (g) of this | ||||||
7 | Section 8.
| ||||||
8 | If any employee who receives an award under this paragraph | ||||||
9 | afterwards
returns to work or is able to do so, and earns or is | ||||||
10 | able to earn as
much as before the accident, payments under | ||||||
11 | such award shall cease. If
such employee returns to work, or is | ||||||
12 | able to do so, and earns or is able
to earn part but not as much | ||||||
13 | as before the accident, such award shall be
modified so as to | ||||||
14 | conform to an award under paragraph (d) of this
Section. If | ||||||
15 | such award is terminated or reduced under the provisions of
| ||||||
16 | this paragraph, such employees have the right at any time | ||||||
17 | within 30
months after the date of such termination or | ||||||
18 | reduction to file petition
with the Commission for the purpose | ||||||
19 | of determining whether any
disability exists as a result of the | ||||||
20 | original accidental injury and the
extent thereof.
| ||||||
21 | Disability as enumerated in subdivision 18, paragraph (e) | ||||||
22 | of this
Section is considered complete disability.
| ||||||
23 | If an employee who had previously incurred loss or the | ||||||
24 | permanent and
complete loss of use of one member, through the | ||||||
25 | loss or the permanent
and complete loss of the use of one hand, | ||||||
26 | one arm, one foot, one leg, or
one eye, incurs permanent and |
| |||||||
| |||||||
1 | complete disability through the loss or
the permanent and | ||||||
2 | complete loss of the use of another member, he shall
receive, | ||||||
3 | in addition to the compensation payable by the employer and
| ||||||
4 | after such payments have ceased, an amount from the Second | ||||||
5 | Injury Fund
provided for in paragraph (f) of Section 7, which, | ||||||
6 | together with the
compensation payable from the employer in | ||||||
7 | whose employ he was when the
last accidental injury was | ||||||
8 | incurred, will equal the amount payable for
permanent and | ||||||
9 | complete disability as provided in this paragraph of this
| ||||||
10 | Section.
| ||||||
11 | The custodian of the Second Injury Fund provided for in | ||||||
12 | paragraph (f)
of Section 7 shall be joined with the employer as | ||||||
13 | a party respondent in
the application for adjustment of claim. | ||||||
14 | The application for adjustment
of claim shall state briefly and | ||||||
15 | in general terms the approximate time
and place and manner of | ||||||
16 | the loss of the first member.
| ||||||
17 | In its award the Commission or the Arbitrator shall | ||||||
18 | specifically find
the amount the injured employee shall be | ||||||
19 | weekly paid, the number of
weeks compensation which shall be | ||||||
20 | paid by the employer, the date upon
which payments begin out of | ||||||
21 | the Second Injury Fund provided for in
paragraph (f) of Section | ||||||
22 | 7 of this Act, the length of time the weekly
payments continue, | ||||||
23 | the date upon which the pension payments commence and
the | ||||||
24 | monthly amount of the payments. The Commission shall 30 days | ||||||
25 | after
the date upon which payments out of the Second Injury | ||||||
26 | Fund have begun as
provided in the award, and every month |
| |||||||
| |||||||
1 | thereafter, prepare and submit to
the State Comptroller a | ||||||
2 | voucher for payment for all compensation accrued
to that date | ||||||
3 | at the rate fixed by the Commission. The State Comptroller
| ||||||
4 | shall draw a warrant to the injured employee along with a | ||||||
5 | receipt to be
executed by the injured employee and returned to | ||||||
6 | the Commission. The
endorsed warrant and receipt is a full and | ||||||
7 | complete acquittance to the
Commission for the payment out of | ||||||
8 | the Second Injury Fund. No other
appropriation or warrant is | ||||||
9 | necessary for payment out of the Second
Injury Fund. The Second | ||||||
10 | Injury Fund is appropriated for the purpose of
making payments | ||||||
11 | according to the terms of the awards.
| ||||||
12 | As of July 1, 1980 to July 1, 1982, all claims against and | ||||||
13 | obligations
of the Second Injury Fund shall become claims | ||||||
14 | against and obligations of
the Rate Adjustment Fund to the | ||||||
15 | extent there is insufficient money in the
Second Injury Fund to | ||||||
16 | pay such claims and obligations. In that case, all
references | ||||||
17 | to "Second Injury Fund" in this Section shall also include the
| ||||||
18 | Rate Adjustment Fund.
| ||||||
19 | (g) Every award for permanent total disability entered by | ||||||
20 | the
Commission on and after July 1, 1965 under which | ||||||
21 | compensation payments
shall become due and payable after the | ||||||
22 | effective date of this amendatory
Act, and every award for | ||||||
23 | death benefits or permanent total disability
entered by the | ||||||
24 | Commission on and after the effective date of this
amendatory | ||||||
25 | Act shall be subject to annual adjustments as to the amount
of | ||||||
26 | the compensation rate therein provided. Such adjustments shall |
| |||||||
| |||||||
1 | first
be made on July 15, 1977, and all awards made and entered | ||||||
2 | prior to July
1, 1975 and on July 15 of each year
thereafter. | ||||||
3 | In all other cases such adjustment shall be made on July 15
of | ||||||
4 | the second year next following the date of the entry of the | ||||||
5 | award and
shall further be made on July 15 annually thereafter. | ||||||
6 | If during the
intervening period from the date of the entry of | ||||||
7 | the award, or the last
periodic adjustment, there shall have | ||||||
8 | been an increase in the State's
average weekly wage in covered | ||||||
9 | industries under the Unemployment
Insurance Act, the weekly | ||||||
10 | compensation rate shall be proportionately
increased by the | ||||||
11 | same percentage as the percentage of increase in the
State's | ||||||
12 | average weekly wage in covered industries under the
| ||||||
13 | Unemployment Insurance Act. The increase in the compensation | ||||||
14 | rate
under this paragraph shall in no event bring the total | ||||||
15 | compensation rate
to an amount greater than the prevailing | ||||||
16 | maximum rate at the time that the annual adjustment is made. | ||||||
17 | Such increase
shall be paid in the same manner as herein | ||||||
18 | provided for payments under
the Second Injury Fund to the | ||||||
19 | injured employee, or his dependents, as
the case may be, out of | ||||||
20 | the Rate Adjustment Fund provided
in paragraph (f) of Section 7 | ||||||
21 | of this Act. Payments shall be made at
the same intervals as | ||||||
22 | provided in the award or, at the option of the
Commission, may | ||||||
23 | be made in quarterly payment on the 15th day of January,
April, | ||||||
24 | July and October of each year. In the event of a decrease in
| ||||||
25 | such average weekly wage there shall be no change in the then | ||||||
26 | existing
compensation rate. The within paragraph shall not |
| |||||||
| |||||||
1 | apply to cases where
there is disputed liability and in which a | ||||||
2 | compromise lump sum settlement
between the employer and the | ||||||
3 | injured employee, or his dependents, as the
case may be, has | ||||||
4 | been duly approved by the Illinois Workers' Compensation
| ||||||
5 | Commission.
| ||||||
6 | Provided, that in cases of awards entered by the Commission | ||||||
7 | for
injuries occurring before July 1, 1975, the increases in | ||||||
8 | the
compensation rate adjusted under the foregoing provision of | ||||||
9 | this
paragraph (g) shall be limited to increases in the State's | ||||||
10 | average
weekly wage in covered industries under the | ||||||
11 | Unemployment Insurance Act
occurring after July 1, 1975.
| ||||||
12 | For every accident occurring on or after July 20, 2005 but | ||||||
13 | before the effective date of this amendatory Act of the 94th | ||||||
14 | General Assembly (Senate Bill 1283 of the 94th General | ||||||
15 | Assembly), the annual adjustments to the compensation rate in | ||||||
16 | awards for death benefits or permanent total disability, as | ||||||
17 | provided in this Act, shall be paid by the employer. The | ||||||
18 | adjustment shall be made by the employer on July 15 of the | ||||||
19 | second year next following the date of the entry of the award | ||||||
20 | and shall further be made on July 15 annually thereafter. If | ||||||
21 | during the intervening period from the date of the entry of the | ||||||
22 | award, or the last periodic adjustment, there shall have been | ||||||
23 | an increase in the State's average weekly wage in covered | ||||||
24 | industries under the Unemployment Insurance Act, the employer | ||||||
25 | shall increase the weekly compensation rate proportionately by | ||||||
26 | the same percentage as the percentage of increase in the |
| |||||||
| |||||||
1 | State's average weekly wage in covered industries under the | ||||||
2 | Unemployment Insurance Act. The increase in the compensation | ||||||
3 | rate under this paragraph shall in no event bring the total | ||||||
4 | compensation rate to an amount greater than the prevailing | ||||||
5 | maximum rate at the time that the annual adjustment is made. In | ||||||
6 | the event of a decrease in such average weekly wage there shall | ||||||
7 | be no change in the then existing compensation rate. Such | ||||||
8 | increase shall be paid by the employer in the same manner and | ||||||
9 | at the same intervals as the payment of compensation in the | ||||||
10 | award. This paragraph shall not apply to cases where there is | ||||||
11 | disputed liability and in which a compromise lump sum | ||||||
12 | settlement between the employer and the injured employee, or | ||||||
13 | his or her dependents, as the case may be, has been duly | ||||||
14 | approved by the Illinois Workers' Compensation Commission. | ||||||
15 | The annual adjustments for every award of death benefits or | ||||||
16 | permanent total disability involving accidents occurring | ||||||
17 | before July 20, 2005 and accidents occurring on or after the | ||||||
18 | effective date of this amendatory Act of the 94th General | ||||||
19 | Assembly (Senate Bill 1283 of the 94th General Assembly) shall | ||||||
20 | continue to be paid from the Rate Adjustment Fund pursuant to | ||||||
21 | this paragraph and Section 7(f) of this Act.
| ||||||
22 | (h) In case death occurs from any cause before the total
| ||||||
23 | compensation to which the employee would have been entitled has | ||||||
24 | been
paid, then in case the employee leaves any widow, widower, | ||||||
25 | child, parent
(or any grandchild, grandparent or other lineal | ||||||
26 | heir or any collateral
heir dependent at the time of the |
| |||||||
| |||||||
1 | accident upon the earnings of the
employee to the extent of 50% | ||||||
2 | or more of total dependency) such
compensation shall be paid to | ||||||
3 | the beneficiaries of the deceased employee
and distributed as | ||||||
4 | provided in paragraph (g) of Section 7.
| ||||||
5 | (h-1) In case an injured employee is under legal disability
| ||||||
6 | at the time when any right or privilege accrues to him or her | ||||||
7 | under this
Act, a guardian may be appointed pursuant to law, | ||||||
8 | and may, on behalf
of such person under legal disability, claim | ||||||
9 | and exercise any
such right or privilege with the same effect | ||||||
10 | as if the employee himself
or herself had claimed or exercised | ||||||
11 | the right or privilege. No limitations
of time provided by this | ||||||
12 | Act run so long as the employee who is under legal
disability | ||||||
13 | is without a conservator or guardian.
| ||||||
14 | (i) In case the injured employee is under 16 years of age | ||||||
15 | at the
time of the accident and is illegally employed, the | ||||||
16 | amount of
compensation payable under paragraphs (b), (c), (d), | ||||||
17 | (e) and (f) of this
Section is increased 50%.
| ||||||
18 | However, where an employer has on file an employment | ||||||
19 | certificate
issued pursuant to the Child Labor Law or work | ||||||
20 | permit issued pursuant
to the Federal Fair Labor Standards Act, | ||||||
21 | as amended, or a birth
certificate properly and duly issued, | ||||||
22 | such certificate, permit or birth
certificate is conclusive | ||||||
23 | evidence as to the age of the injured minor
employee for the | ||||||
24 | purposes of this Section.
| ||||||
25 | Nothing herein contained repeals or amends the provisions | ||||||
26 | of the
Child Labor Law relating to the employment of minors |
| |||||||
| |||||||
1 | under the age of 16 years.
| ||||||
2 | (j) 1. In the event the injured employee receives benefits,
| ||||||
3 | including medical, surgical or hospital benefits under any | ||||||
4 | group plan
covering non-occupational disabilities contributed | ||||||
5 | to wholly or
partially by the employer, which benefits should | ||||||
6 | not have been payable
if any rights of recovery existed under | ||||||
7 | this Act, then such amounts so
paid to the employee from any | ||||||
8 | such group plan as shall be consistent
with, and limited to, | ||||||
9 | the provisions of paragraph 2 hereof, shall be
credited to or | ||||||
10 | against any compensation payment for temporary total
| ||||||
11 | incapacity for work or any medical, surgical or hospital | ||||||
12 | benefits made
or to be made under this Act. In such event, the | ||||||
13 | period of time for
giving notice of accidental injury and | ||||||
14 | filing application for adjustment
of claim does not commence to | ||||||
15 | run until the termination of such
payments. This paragraph does | ||||||
16 | not apply to payments made under any
group plan which would | ||||||
17 | have been payable irrespective of an accidental
injury under | ||||||
18 | this Act. Any employer receiving such credit shall keep
such | ||||||
19 | employee safe and harmless from any and all claims or | ||||||
20 | liabilities
that may be made against him by reason of having | ||||||
21 | received such payments
only to the extent of such credit.
| ||||||
22 | Any excess benefits paid to or on behalf of a State | ||||||
23 | employee by the
State Employees' Retirement System under | ||||||
24 | Article 14 of the Illinois Pension
Code on a death claim or | ||||||
25 | disputed disability claim shall be credited
against any | ||||||
26 | payments made or to be made by the State of Illinois to or on
|
| |||||||
| |||||||
1 | behalf of such employee under this Act, except for payments for | ||||||
2 | medical
expenses which have already been incurred at the time | ||||||
3 | of the award. The
State of Illinois shall directly reimburse | ||||||
4 | the State Employees' Retirement
System to the extent of such | ||||||
5 | credit.
| ||||||
6 | 2. Nothing contained in this Act shall be construed to give | ||||||
7 | the
employer or the insurance carrier the right to credit for | ||||||
8 | any benefits
or payments received by the employee other than | ||||||
9 | compensation payments
provided by this Act, and where the | ||||||
10 | employee receives payments other
than compensation payments, | ||||||
11 | whether as full or partial salary, group
insurance benefits, | ||||||
12 | bonuses, annuities or any other payments, the
employer or | ||||||
13 | insurance carrier shall receive credit for each such payment
| ||||||
14 | only to the extent of the compensation that would have been | ||||||
15 | payable
during the period covered by such payment.
| ||||||
16 | 3. The extension of time for the filing of an Application | ||||||
17 | for
Adjustment of Claim as provided in paragraph 1 above shall | ||||||
18 | not apply to
those cases where the time for such filing had | ||||||
19 | expired prior to the date
on which payments or benefits | ||||||
20 | enumerated herein have been initiated or
resumed. Provided | ||||||
21 | however that this paragraph 3 shall apply only to
cases wherein | ||||||
22 | the payments or benefits hereinabove enumerated shall be
| ||||||
23 | received after July 1, 1969.
| ||||||
24 | (Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813, | ||||||
25 | eff. 7-13-12.)
|
| |||||||
| |||||||
1 | (820 ILCS 305/8.1b) | ||||||
2 | Sec. 8.1b. Determination of permanent partial disability. | ||||||
3 | For accidental injuries that occur on or after September 1, | ||||||
4 | 2011, permanent partial disability shall be established using | ||||||
5 | the following criteria: | ||||||
6 | (a) A physician licensed to practice medicine in all of its | ||||||
7 | branches preparing a permanent partial disability impairment | ||||||
8 | report shall report the level of impairment in writing. The | ||||||
9 | report shall include an evaluation of medically defined and | ||||||
10 | professionally appropriate measurements of impairment that | ||||||
11 | include, but are not limited to: loss of range of motion; loss | ||||||
12 | of strength; measured atrophy of tissue mass consistent with | ||||||
13 | the injury; and any other measurements that establish the | ||||||
14 | nature and extent of the impairment. The most current edition | ||||||
15 | of the American Medical Association's "Guides to the Evaluation | ||||||
16 | of Permanent Impairment" shall be used by the physician in | ||||||
17 | determining the level of impairment. | ||||||
18 | (b) In determining the level of permanent partial | ||||||
19 | disability, the Commission shall base its determination on the | ||||||
20 | following factors: (i) the reported level of impairment | ||||||
21 | pursuant to subsection (a) if such a report exists ; (ii) the | ||||||
22 | occupation of the injured employee; (iii) the age of the | ||||||
23 | employee at the time of the injury; (iv) the employee's future | ||||||
24 | earning capacity; and (v) evidence of disability corroborated | ||||||
25 | by objective findings in the treating medical records and | ||||||
26 | independent medical examinations . No single enumerated factor |
| |||||||
| |||||||
1 | shall be the sole determinant of disability. In determining the | ||||||
2 | level of disability, the relevance and weight of any factors | ||||||
3 | used in addition to the level of impairment as reported by the | ||||||
4 | physician must be explained in a written order.
| ||||||
5 | (c) A report of impairment prepared pursuant to subsection
| ||||||
6 | (a) is not required for the arbitrator or Commission to approve | ||||||
7 | a Settlement Contract Lump Sum Petition. | ||||||
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 | ||||||
12 | procedures, treatments, or services covered under this Act and | ||||||
13 | rendered or to be rendered on and after February 1, 2006, the | ||||||
14 | maximum allowable payment shall be 90% of the 80th percentile | ||||||
15 | of charges and fees as determined by the Commission utilizing | ||||||
16 | information provided by employers' and insurers' national | ||||||
17 | databases, with a minimum of 12,000,000 Illinois line item | ||||||
18 | charges and fees comprised of health care provider and hospital | ||||||
19 | charges and fees as of August 1, 2004 but not earlier than | ||||||
20 | August 1, 2002. These charges and fees are provider billed | ||||||
21 | amounts and shall not include discounted charges. The 80th | ||||||
22 | percentile is the point on an ordered data set from low to high | ||||||
23 | such that 80% of the cases are below or equal to that point and | ||||||
24 | at most 20% are above or equal to that point. The Commission | ||||||
25 | shall adjust these historical charges and fees as of August 1, |
| |||||||
| |||||||
1 | 2004 by the Consumer Price Index-U for the period August 1, | ||||||
2 | 2004 through September 30, 2005. The Commission shall establish | ||||||
3 | fee schedules for procedures, treatments, or services for | ||||||
4 | hospital inpatient, hospital outpatient, emergency room and | ||||||
5 | trauma, ambulatory surgical treatment centers, and | ||||||
6 | professional services. These charges and fees shall be | ||||||
7 | designated by geozip or any smaller geographic unit. The data | ||||||
8 | shall in no way identify or tend to identify any patient, | ||||||
9 | employer, or health care provider. As used in this Section, | ||||||
10 | "geozip" means a three-digit zip code based on data | ||||||
11 | similarities, geographical similarities, and frequencies. A | ||||||
12 | geozip does not cross state boundaries. As used in this | ||||||
13 | Section, "three-digit zip code" means a geographic area in | ||||||
14 | which all zip codes have the same first 3 digits. If a geozip | ||||||
15 | does not have the necessary number of charges and fees to | ||||||
16 | calculate a valid percentile for a specific procedure, | ||||||
17 | treatment, or service, the Commission may combine data from the | ||||||
18 | geozip with up to 4 other geozips that are demographically and | ||||||
19 | economically similar and exhibit similarities in data and | ||||||
20 | frequencies until the Commission reaches 9 charges or fees for | ||||||
21 | that specific procedure, treatment, or service. In cases where | ||||||
22 | the compiled data contains less than 9 charges or fees for a | ||||||
23 | procedure, treatment, or service, reimbursement shall occur at | ||||||
24 | 76% of charges and fees as determined by the Commission in a | ||||||
25 | manner consistent with the provisions of this paragraph. | ||||||
26 | Providers of out-of-state procedures, treatments, services, |
| |||||||
| |||||||
1 | products, or supplies shall be reimbursed at the lesser of that | ||||||
2 | state's fee schedule amount or the fee schedule amount for the | ||||||
3 | region in which the employee resides. If no fee schedule exists | ||||||
4 | in that state, the provider shall be reimbursed at the lesser | ||||||
5 | of the actual charge or the fee schedule amount for the region | ||||||
6 | in which the employee resides. Not later than September 30 in | ||||||
7 | 2006 and each year thereafter, the Commission shall | ||||||
8 | automatically increase or decrease the maximum allowable | ||||||
9 | payment for a procedure, treatment, or service established and | ||||||
10 | in effect on January 1 of that year by the percentage change in | ||||||
11 | the Consumer Price Index-U for the 12 month period ending | ||||||
12 | August 31 of that year. The increase or decrease shall become | ||||||
13 | effective on January 1 of the following year. As used in this | ||||||
14 | Section, "Consumer Price Index-U" means the index published by | ||||||
15 | the Bureau of Labor Statistics of the U.S. Department of Labor, | ||||||
16 | that measures the average change in prices of all goods and | ||||||
17 | services purchased by all urban consumers, U.S. city average, | ||||||
18 | all items, 1982-84=100. | ||||||
19 | (a-1) Notwithstanding the provisions of subsection (a) and | ||||||
20 | unless otherwise indicated, the following provisions shall | ||||||
21 | apply to the medical fee schedule starting on September 1, | ||||||
22 | 2011: | ||||||
23 | (1) The Commission shall establish and maintain fee | ||||||
24 | schedules for procedures, treatments, products, services, | ||||||
25 | or supplies for hospital inpatient, hospital outpatient, | ||||||
26 | emergency room, ambulatory surgical treatment centers, |
| |||||||
| |||||||
1 | accredited ambulatory surgical treatment facilities, | ||||||
2 | prescriptions filled and dispensed outside of a licensed | ||||||
3 | pharmacy, dental services, and professional services. This | ||||||
4 | fee schedule shall be based on the fee schedule amounts | ||||||
5 | already established by the Commission pursuant to | ||||||
6 | subsection (a) of this Section. However, starting on | ||||||
7 | January 1, 2012, these fee schedule amounts shall be | ||||||
8 | grouped into geographic regions in the following manner: | ||||||
9 | (A) Four regions for non-hospital fee schedule | ||||||
10 | amounts shall be utilized: | ||||||
11 | (i) Cook County; | ||||||
12 | (ii) DuPage, Kane, Lake, and Will Counties; | ||||||
13 | (iii) Bond, Calhoun, Clinton, Jersey, | ||||||
14 | Macoupin, Madison, Monroe, Montgomery, Randolph, | ||||||
15 | St. Clair, and Washington Counties; and | ||||||
16 | (iv) All other counties of the State. | ||||||
17 | (B) Fourteen regions for hospital fee schedule | ||||||
18 | amounts shall be utilized: | ||||||
19 | (i) Cook, DuPage, Will, Kane, McHenry, DeKalb, | ||||||
20 | Kendall, and Grundy Counties; | ||||||
21 | (ii) Kankakee County; | ||||||
22 | (iii) Madison, St. Clair, Macoupin, Clinton, | ||||||
23 | Monroe, Jersey, Bond, and Calhoun Counties; | ||||||
24 | (iv) Winnebago and Boone Counties; | ||||||
25 | (v) Peoria, Tazewell, Woodford, Marshall, and | ||||||
26 | Stark Counties; |
| |||||||
| |||||||
1 | (vi) Champaign, Piatt, and Ford Counties; | ||||||
2 | (vii) Rock Island, Henry, and Mercer Counties; | ||||||
3 | (viii) Sangamon and Menard Counties; | ||||||
4 | (ix) McLean County; | ||||||
5 | (x) Lake County; | ||||||
6 | (xi) Macon County; | ||||||
7 | (xii) Vermilion County; | ||||||
8 | (xiii) Alexander County; and | ||||||
9 | (xiv) All other counties of the State. | ||||||
10 | (2) If a geozip, as defined in subsection (a) of this | ||||||
11 | Section, overlaps into one or more of the regions set forth | ||||||
12 | in this Section, then the Commission shall average or | ||||||
13 | repeat the charges and fees in a geozip in order to | ||||||
14 | designate charges and fees for each region. | ||||||
15 | (3) In cases where the compiled data contains less than | ||||||
16 | 9 charges or fees for a procedure, treatment, product, | ||||||
17 | supply, or service or where the fee schedule amount cannot | ||||||
18 | be determined by the non-discounted charge data, | ||||||
19 | non-Medicare relative values and conversion factors | ||||||
20 | derived from established fee schedule amounts, coding | ||||||
21 | crosswalks, or other data as determined by the Commission, | ||||||
22 | reimbursement shall occur at 76% of charges and fees until | ||||||
23 | September 1, 2011 and 53.2% of charges and fees thereafter | ||||||
24 | as determined by the Commission in a manner consistent with | ||||||
25 | the provisions of this paragraph. | ||||||
26 | (4) To establish additional fee schedule amounts, the |
| |||||||
| |||||||
1 | Commission shall utilize provider non-discounted charge | ||||||
2 | data, non-Medicare relative values and conversion factors | ||||||
3 | derived from established fee schedule amounts, and coding | ||||||
4 | crosswalks. The Commission may establish additional fee | ||||||
5 | schedule amounts based on either the charge or cost of the | ||||||
6 | procedure, treatment, product, supply, or service. | ||||||
7 | (5) Implants shall be reimbursed at 25% above the net | ||||||
8 | manufacturer's invoice price less rebates, plus actual | ||||||
9 | reasonable and customary shipping charges whether or not | ||||||
10 | the implant charge is submitted by a provider in | ||||||
11 | conjunction with a bill for all other services associated | ||||||
12 | with the implant, submitted by a provider on a separate | ||||||
13 | claim form, submitted by a distributor, or submitted by the | ||||||
14 | manufacturer of the implant. "Implants" include the | ||||||
15 | following codes or any substantially similar updated code | ||||||
16 | as determined by the Commission: 0274 | ||||||
17 | (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens | ||||||
18 | implant); 0278 (implants); 0540 and 0545 (ambulance); 0624 | ||||||
19 | (investigational devices); and 0636 (drugs requiring | ||||||
20 | detailed coding). Non-implantable devices or supplies | ||||||
21 | within these codes shall be reimbursed at 65% of actual | ||||||
22 | charge, which is the provider's normal rates under its | ||||||
23 | standard chargemaster. A standard chargemaster is the | ||||||
24 | provider's list of charges for procedures, treatments, | ||||||
25 | products, supplies, or services used to bill payers in a | ||||||
26 | consistent manner. |
| |||||||
| |||||||
1 | (6) The Commission shall automatically update all | ||||||
2 | codes and associated rules with the version of the codes | ||||||
3 | and rules valid on January 1 of that year. | ||||||
4 | (a-2) For procedures, treatments, services, or supplies | ||||||
5 | covered under this Act and rendered or to be rendered on or | ||||||
6 | after September 1, 2011, the maximum allowable payment shall be | ||||||
7 | 70% of the fee schedule amounts, which shall be adjusted yearly | ||||||
8 | by the Consumer Price Index-U, as described in subsection (a) | ||||||
9 | of this Section. | ||||||
10 | (a-2.5) For procedures, treatments, services, or supplies | ||||||
11 | covered under this Act and rendered or to be rendered on or | ||||||
12 | after June 1, 2016, the maximum allowable payment for the | ||||||
13 | following service categories set forth in Title 50, Section | ||||||
14 | 7110.90 of the Illinois Administrative Code shall be 70% of the | ||||||
15 | fee schedule amounts in effect on May 31, 2016, which shall be | ||||||
16 | adjusted yearly by the Consumer Price Index-U, as described in | ||||||
17 | subsection (a) of this Section: | ||||||
18 | (1) Section 1: Ambulatory Surgical Treatment Center | ||||||
19 | (ASTC) and Accredited Ambulatory Surgical Treatment | ||||||
20 | Facility (ASTF). | ||||||
21 | (2) Section 2: Anesthesia. | ||||||
22 | (3) Section 6: Hospital Inpatient Services: Standard | ||||||
23 | and Trauma. | ||||||
24 | (4) Section 7: Hospital Outpatient. | ||||||
25 | (5) Section 8: Professional Services. | ||||||
26 | The 30% reduction shall not apply to any procedure, |
| |||||||
| |||||||
1 | treatment, or service classified by an evaluation and | ||||||
2 | management code or a physical medicine code on the fee | ||||||
3 | schedule. | ||||||
4 | (a-3) Prescriptions filled and dispensed outside of a | ||||||
5 | licensed pharmacy shall be subject to a fee schedule that shall | ||||||
6 | not exceed the Average Wholesale Price (AWP) plus a dispensing | ||||||
7 | fee of $4.18. AWP or its equivalent as registered by the | ||||||
8 | National Drug Code shall be set forth for that drug on that | ||||||
9 | date as published in Medispan. | ||||||
10 | (b) Notwithstanding the provisions of subsection (a), if
| ||||||
11 | the Commission finds that there is a significant limitation on
| ||||||
12 | access to quality health care in either a specific field of
| ||||||
13 | health care services or a specific geographic limitation on
| ||||||
14 | access to health care, it may change the Consumer Price Index-U
| ||||||
15 | increase or decrease for that specific field or specific
| ||||||
16 | geographic limitation on access to health care to address that
| ||||||
17 | limitation. | ||||||
18 | (c) The Commission shall establish by rule a process to | ||||||
19 | review those medical cases or outliers that involve | ||||||
20 | extra-ordinary treatment to determine whether to make an | ||||||
21 | additional adjustment to the maximum payment within a fee | ||||||
22 | schedule for a procedure, treatment, or service. | ||||||
23 | (d) When a patient notifies a provider that the treatment, | ||||||
24 | procedure, or service being sought is for a work-related | ||||||
25 | illness or injury and furnishes the provider the name and | ||||||
26 | address of the responsible employer, the provider shall bill |
| |||||||
| |||||||
1 | the employer directly. The employer shall make payment and | ||||||
2 | providers shall submit bills and records in accordance with the | ||||||
3 | provisions of this Section. | ||||||
4 | (1) All payments to providers for treatment provided | ||||||
5 | pursuant to this Act shall be made within 30 days of | ||||||
6 | receipt of the bills as long as the claim contains | ||||||
7 | substantially all the required data elements necessary to | ||||||
8 | adjudicate the bills. | ||||||
9 | (2) If the claim does not contain substantially all the | ||||||
10 | required data elements necessary to adjudicate the bill, or | ||||||
11 | the claim is denied for any other reason, in whole or in | ||||||
12 | part, the employer or insurer shall provide written | ||||||
13 | notification, explaining the basis for the denial and | ||||||
14 | describing any additional necessary data elements, to the | ||||||
15 | provider within 30 days of receipt of the bill. | ||||||
16 | (3) In the case of nonpayment to a provider within 30 | ||||||
17 | days of receipt of the bill which contained substantially | ||||||
18 | all of the required data elements necessary to adjudicate | ||||||
19 | the bill or nonpayment to a provider of a portion of such a | ||||||
20 | bill up to the lesser of the actual charge or the payment | ||||||
21 | level set by the Commission in the fee schedule established | ||||||
22 | in this Section, the bill, or portion of the bill, shall | ||||||
23 | incur interest at a rate of 1% per month payable to the | ||||||
24 | provider. Any required interest payments shall be made | ||||||
25 | within 30 days after payment. | ||||||
26 | (e) Except as provided in subsections (e-5), (e-10), and |
| |||||||
| |||||||
1 | (e-15), a provider shall not hold an employee liable for costs | ||||||
2 | related to a non-disputed procedure, treatment, or service | ||||||
3 | rendered in connection with a compensable injury. The | ||||||
4 | provisions of subsections (e-5), (e-10), (e-15), and (e-20) | ||||||
5 | shall not apply if an employee provides information to the | ||||||
6 | provider regarding participation in a group health plan. If the | ||||||
7 | employee participates in a group health plan, the provider may | ||||||
8 | submit a claim for services to the group health plan. If the | ||||||
9 | claim for service is covered by the group health plan, the | ||||||
10 | employee's responsibility shall be limited to applicable | ||||||
11 | deductibles, co-payments, or co-insurance. Except as provided | ||||||
12 | under subsections (e-5), (e-10), (e-15), and (e-20), a provider | ||||||
13 | shall not bill or otherwise attempt to recover from the | ||||||
14 | employee the difference between the provider's charge and the | ||||||
15 | amount paid by the employer or the insurer on a compensable | ||||||
16 | injury, or for medical services or treatment determined by the | ||||||
17 | Commission to be excessive or unnecessary. | ||||||
18 | (e-5) If an employer notifies a provider that the employer | ||||||
19 | does not consider the illness or injury to be compensable under | ||||||
20 | this Act, the provider may seek payment of the provider's | ||||||
21 | actual charges from the employee for any procedure, treatment, | ||||||
22 | or service rendered. Once an employee informs the provider that | ||||||
23 | there is an application filed with the Commission to resolve a | ||||||
24 | dispute over payment of such charges, the provider shall cease | ||||||
25 | any and all efforts to collect payment for the services that | ||||||
26 | are the subject of the dispute. Any statute of limitations or |
| |||||||
| |||||||
1 | statute of repose applicable to the provider's efforts to | ||||||
2 | collect payment from the employee shall be tolled from the date | ||||||
3 | that the employee files the application with the Commission | ||||||
4 | until the date that the provider is permitted to resume | ||||||
5 | collection efforts under the provisions of this Section. | ||||||
6 | (e-10) If an employer notifies a provider that the employer | ||||||
7 | will pay only a portion of a bill for any procedure, treatment, | ||||||
8 | or service rendered in connection with a compensable illness or | ||||||
9 | disease, the provider may seek payment from the employee for | ||||||
10 | the remainder of the amount of the bill up to the lesser of the | ||||||
11 | actual charge, negotiated rate, if applicable, or the payment | ||||||
12 | level set by the Commission in the fee schedule established in | ||||||
13 | this Section. Once an employee informs the provider that there | ||||||
14 | is an application filed with the Commission to resolve a | ||||||
15 | dispute over payment of such charges, the provider shall cease | ||||||
16 | any and all efforts to collect payment for the services that | ||||||
17 | are the subject of the dispute. Any statute of limitations or | ||||||
18 | statute of repose applicable to the provider's efforts to | ||||||
19 | collect payment from the employee shall be tolled from the date | ||||||
20 | that the employee files the application with the Commission | ||||||
21 | until the date that the provider is permitted to resume | ||||||
22 | collection efforts under the provisions of this Section. | ||||||
23 | (e-15) When there is a dispute over the compensability of | ||||||
24 | or amount of payment for a procedure, treatment, or service, | ||||||
25 | and a case is pending or proceeding before an Arbitrator or the | ||||||
26 | Commission, the provider may mail the employee reminders that |
| |||||||
| |||||||
1 | the employee will be responsible for payment of any procedure, | ||||||
2 | treatment or service rendered by the provider. The reminders | ||||||
3 | must state that they are not bills, to the extent practicable | ||||||
4 | include itemized information, and state that the employee need | ||||||
5 | not pay until such time as the provider is permitted to resume | ||||||
6 | collection efforts under this Section. The reminders shall not | ||||||
7 | be provided to any credit rating agency. The reminders may | ||||||
8 | request that the employee furnish the provider with information | ||||||
9 | about the proceeding under this Act, such as the file number, | ||||||
10 | names of parties, and status of the case. If an employee fails | ||||||
11 | to respond to such request for information or fails to furnish | ||||||
12 | the information requested within 90 days of the date of the | ||||||
13 | reminder, the provider is entitled to resume any and all | ||||||
14 | efforts to collect payment from the employee for the services | ||||||
15 | rendered to the employee and the employee shall be responsible | ||||||
16 | for payment of any outstanding bills for a procedure, | ||||||
17 | treatment, or service rendered by a provider. | ||||||
18 | (e-20) Upon a final award or judgment by an Arbitrator or | ||||||
19 | the Commission, or a settlement agreed to by the employer and | ||||||
20 | the employee, a provider may resume any and all efforts to | ||||||
21 | collect payment from the employee for the services rendered to | ||||||
22 | the employee and the employee shall be responsible for payment | ||||||
23 | of any outstanding bills for a procedure, treatment, or service | ||||||
24 | rendered by a provider as well as the interest awarded under | ||||||
25 | subsection (d) of this Section. In the case of a procedure, | ||||||
26 | treatment, or service deemed compensable, the provider shall |
| |||||||
| |||||||
1 | not require a payment rate, excluding the interest provisions | ||||||
2 | under subsection (d), greater than the lesser of the actual | ||||||
3 | charge or the payment level set by the Commission in the fee | ||||||
4 | schedule established in this Section. Payment for services | ||||||
5 | deemed not covered or not compensable under this Act is the | ||||||
6 | responsibility of the employee unless a provider and employee | ||||||
7 | have agreed otherwise in writing. Services not covered or not | ||||||
8 | compensable under this Act are not subject to the fee schedule | ||||||
9 | in this Section. | ||||||
10 | (f) Nothing in this Act shall prohibit an employer or
| ||||||
11 | insurer from contracting with a health care provider or group
| ||||||
12 | of health care providers for reimbursement levels for benefits | ||||||
13 | under this Act different
from those provided in this Section. | ||||||
14 | (g) On or before January 1, 2010 the Commission shall | ||||||
15 | provide to the Governor and General Assembly a report regarding | ||||||
16 | the implementation of the medical fee schedule and the index | ||||||
17 | used for annual adjustment to that schedule as described in | ||||||
18 | this Section.
| ||||||
19 | (Source: P.A. 97-18, eff. 6-28-11.)
| ||||||
20 | (820 ILCS 305/8.2a) | ||||||
21 | Sec. 8.2a. Electronic claims. | ||||||
22 | (a) The Illinois Workers' Compensation Commission Director | ||||||
23 | of Insurance shall adopt rules to do all of the following: | ||||||
24 | (1) Ensure that all health care providers and | ||||||
25 | facilities submit medical bills for payment on |
| |||||||
| |||||||
1 | standardized forms. | ||||||
2 | (2) Require acceptance by employers and insurers of | ||||||
3 | electronic claims for payment of medical services. | ||||||
4 | (3) Ensure confidentiality of medical information | ||||||
5 | submitted on electronic claims for payment of medical | ||||||
6 | services. | ||||||
7 | (4) Ensure that the rules establishing electronic | ||||||
8 | claims include a specific enforcement mechanism to ensure | ||||||
9 | compliance with these rules. | ||||||
10 | (5) Ensure that health care providers have at least 15 | ||||||
11 | business days to comply with records requested by employers | ||||||
12 | and insurers for the authorization of the payment of | ||||||
13 | workers' compensation claims. | ||||||
14 | (b) To the extent feasible, standards adopted pursuant to | ||||||
15 | subdivision (a) shall be consistent with existing standards | ||||||
16 | under the federal Health Insurance Portability and | ||||||
17 | Accountability Act of 1996 and standards adopted under the | ||||||
18 | Illinois Health Information Exchange and Technology Act. | ||||||
19 | (c) The rules requiring employers and insurers to accept | ||||||
20 | electronic claims for payment of medical services shall be | ||||||
21 | proposed on or before May 31, 2016 January 1, 2012 , and shall | ||||||
22 | require all employers and insurers to accept electronic claims | ||||||
23 | for payment of medical services on or before January 1, 2017 | ||||||
24 | June 30, 2012 . | ||||||
25 | (d) The Illinois Workers' Compensation Commission Director | ||||||
26 | of Insurance shall by rule establish criteria for granting |
| |||||||
| |||||||
1 | exceptions to employers, insurance carriers, and health care | ||||||
2 | providers who are unable to submit or accept medical bills | ||||||
3 | electronically.
| ||||||
4 | (Source: P.A. 97-18, eff. 6-28-11.)
| ||||||
5 | (820 ILCS 305/14) (from Ch. 48, par. 138.14)
| ||||||
6 | Sec. 14. The Commission shall appoint a secretary, an | ||||||
7 | assistant
secretary, and arbitrators and shall employ such
| ||||||
8 | assistants and clerical help as may be necessary. Arbitrators | ||||||
9 | shall be appointed pursuant to this Section, notwithstanding | ||||||
10 | any provision of the Personnel Code.
| ||||||
11 | Each arbitrator appointed after June 28, 2011 shall be | ||||||
12 | required
to demonstrate in writing his or
her knowledge of and | ||||||
13 | expertise in the law of and judicial processes of
the Workers' | ||||||
14 | Compensation Act and the Occupational Diseases Act.
| ||||||
15 | A formal training program for newly-hired arbitrators | ||||||
16 | shall be
implemented. The training program shall include the | ||||||
17 | following:
| ||||||
18 | (a) substantive and procedural aspects of the | ||||||
19 | arbitrator position;
| ||||||
20 | (b) current issues in workers' compensation law and | ||||||
21 | practice;
| ||||||
22 | (c) medical lectures by specialists in areas such as | ||||||
23 | orthopedics,
ophthalmology, psychiatry, rehabilitation | ||||||
24 | counseling;
| ||||||
25 | (d) orientation to each operational unit of the |
| |||||||
| |||||||
1 | Illinois Workers' Compensation Commission;
| ||||||
2 | (e) observation of experienced arbitrators conducting | ||||||
3 | hearings of cases,
combined with the opportunity to discuss | ||||||
4 | evidence presented and rulings made;
| ||||||
5 | (f) the use of hypothetical cases requiring the trainee | ||||||
6 | to issue
judgments as a means to evaluating knowledge and | ||||||
7 | writing ability;
| ||||||
8 | (g) writing skills;
| ||||||
9 | (h) professional and ethical standards pursuant to | ||||||
10 | Section 1.1 of this Act; | ||||||
11 | (i) detection of workers' compensation fraud and | ||||||
12 | reporting obligations of Commission employees and | ||||||
13 | appointees; | ||||||
14 | (j) standards of evidence-based medical treatment and | ||||||
15 | best practices for measuring and improving quality and | ||||||
16 | health care outcomes in the workers' compensation system, | ||||||
17 | including but not limited to the use of the American | ||||||
18 | Medical Association's "Guides to the Evaluation of | ||||||
19 | Permanent Impairment" and the practice of utilization | ||||||
20 | review; and | ||||||
21 | (k) substantive and procedural aspects of coal | ||||||
22 | workers' pneumoconiosis (black lung) cases. | ||||||
23 | A formal and ongoing professional development program | ||||||
24 | including, but not
limited to, the above-noted areas shall be | ||||||
25 | implemented to keep arbitrators
informed of recent | ||||||
26 | developments and issues and to assist them in
maintaining and |
| |||||||
| |||||||
1 | enhancing their professional competence. Each arbitrator shall | ||||||
2 | complete 20 hours of training in the above-noted areas during | ||||||
3 | every 2 years such arbitrator shall remain in office.
| ||||||
4 | Each
arbitrator shall devote full time to his or her duties | ||||||
5 | and shall serve when
assigned as
an acting Commissioner when a | ||||||
6 | Commissioner is unavailable in accordance
with the provisions | ||||||
7 | of Section 13 of this Act. Any
arbitrator who is an | ||||||
8 | attorney-at-law shall not engage in the practice of
law, nor | ||||||
9 | shall any arbitrator hold any other office or position of
| ||||||
10 | profit under the United States or this State or any municipal
| ||||||
11 | corporation or political subdivision of this State.
| ||||||
12 | Notwithstanding any other provision of this Act to the | ||||||
13 | contrary, an arbitrator
who serves as an acting Commissioner in | ||||||
14 | accordance with the provisions of
Section 13 of this Act shall | ||||||
15 | continue to serve in the capacity of Commissioner
until a | ||||||
16 | decision is reached in every case heard by that arbitrator | ||||||
17 | while
serving as an acting Commissioner.
| ||||||
18 | Notwithstanding any other provision of this Section, the | ||||||
19 | term of all arbitrators serving on the effective date of this | ||||||
20 | amendatory Act of the 97th General Assembly, including any | ||||||
21 | arbitrators on administrative leave, shall terminate at the | ||||||
22 | close of business on July 1, 2011, but the incumbents shall | ||||||
23 | continue to exercise all of their duties until they are | ||||||
24 | reappointed or their successors are appointed. | ||||||
25 | On and after the effective date of this amendatory Act of | ||||||
26 | the 97th General Assembly, arbitrators shall be appointed to |
| |||||||
| |||||||
1 | 3-year terms as follows: | ||||||
2 | (1) All appointments shall be made by the Governor with | ||||||
3 | the advice and consent of the Senate. | ||||||
4 | (2) For their initial appointments, 12 arbitrators | ||||||
5 | shall be appointed to terms expiring July 1, 2012; 12 | ||||||
6 | arbitrators shall be appointed to terms expiring July 1, | ||||||
7 | 2013; and all additional arbitrators shall be appointed to | ||||||
8 | terms expiring July 1, 2014. Thereafter, all arbitrators | ||||||
9 | shall be appointed to 3-year terms. | ||||||
10 | Upon the expiration of a term, the Chairman shall evaluate | ||||||
11 | the performance of the arbitrator and may recommend to the | ||||||
12 | Governor that he or she be reappointed to a second or | ||||||
13 | subsequent term by the Governor with the advice and consent of | ||||||
14 | the Senate. | ||||||
15 | Each arbitrator appointed on or after the effective date of | ||||||
16 | this amendatory Act of the 97th General Assembly and who has | ||||||
17 | not previously served as an arbitrator for the Commission shall | ||||||
18 | be required to be authorized to practice law in this State by | ||||||
19 | the Supreme Court, and to maintain this authorization | ||||||
20 | throughout his or her term of employment.
| ||||||
21 | The performance of all arbitrators shall be reviewed by the | ||||||
22 | Chairman on
an annual basis. The Chairman shall allow input | ||||||
23 | from the Commissioners in
all such reviews.
| ||||||
24 | The Commission shall assign no fewer than 3 arbitrators to | ||||||
25 | each hearing site. The Commission shall establish a procedure | ||||||
26 | to ensure that the arbitrators assigned to each hearing site |
| |||||||
| |||||||
1 | are assigned cases on a random basis. The Chairman of the | ||||||
2 | Workers' Compensation Commission shall have discretion to | ||||||
3 | assign and reassign arbitrators to each hearing site as needed. | ||||||
4 | No arbitrator shall hear cases in any county, other than Cook | ||||||
5 | County, for more than 2 years in each 3-year term. | ||||||
6 | The Secretary and each arbitrator shall receive a per annum | ||||||
7 | salary of
$4,000 less than the per annum salary of members of | ||||||
8 | The
Illinois Workers' Compensation Commission as
provided in | ||||||
9 | Section 13 of this Act, payable in equal monthly installments.
| ||||||
10 | The members of the Commission, Arbitrators and other | ||||||
11 | employees whose
duties require them to travel, shall have | ||||||
12 | reimbursed to them their
actual traveling expenses and | ||||||
13 | disbursements made or incurred by them in
the discharge of | ||||||
14 | their official duties while away from their place of
residence | ||||||
15 | in the performance of their duties.
| ||||||
16 | The Commission shall provide itself with a seal for the
| ||||||
17 | authentication of its orders, awards and proceedings upon which | ||||||
18 | shall be
inscribed the name of the Commission and the words | ||||||
19 | "Illinois--Seal".
| ||||||
20 | The Secretary or Assistant Secretary, under the direction | ||||||
21 | of the
Commission, shall have charge and custody of the seal of | ||||||
22 | the Commission
and also have charge and custody of all records, | ||||||
23 | files, orders,
proceedings, decisions, awards and other | ||||||
24 | documents on file with the
Commission. He shall furnish | ||||||
25 | certified copies, under the seal of the
Commission, of any such | ||||||
26 | records, files, orders, proceedings, decisions,
awards and |
| |||||||
| |||||||
1 | other documents on file with the Commission as may be
required. | ||||||
2 | Certified copies so furnished by the Secretary or Assistant
| ||||||
3 | Secretary shall be received in evidence before the Commission | ||||||
4 | or any
Arbitrator thereof, and in all courts, provided that the | ||||||
5 | original of
such certified copy is otherwise competent and | ||||||
6 | admissible in evidence.
The Secretary or Assistant Secretary | ||||||
7 | shall perform such other duties as
may be prescribed from time | ||||||
8 | to time by the Commission.
| ||||||
9 | (Source: P.A. 97-18, eff. 6-28-11; 97-719, eff. 6-29-12; 98-40, | ||||||
10 | eff. 6-28-13.)
| ||||||
11 | (820 ILCS 305/14.2 new) | ||||||
12 | Sec. 14.2. Workers' Compensation Ombudsman Program. | ||||||
13 | (a) The Illinois Workers' Compensation Commission shall | ||||||
14 | establish the Workers' Compensation Ombudsman Program as a | ||||||
15 | program within the Commission no later than July 1, 2016. The | ||||||
16 | Ombudsman Program shall provide assistance to all regions of | ||||||
17 | the State. The Ombudsman Program shall be staffed with | ||||||
18 | personnel who are trained in techniques performed by ombudsmen | ||||||
19 | and who are familiar with the Commission. | ||||||
20 | The Ombudsman Program may: | ||||||
21 | (1) assist injured workers with the use of the | ||||||
22 | Commission's information portal; | ||||||
23 | (2) provide information to employers, employees, and | ||||||
24 | medical provider with questions about workers' | ||||||
25 | compensation fraud; |
| |||||||
| |||||||
1 | (3) assist injured employees with referral to local, | ||||||
2 | State, and federal financial assistance, rehabilitation, | ||||||
3 | and work placement programs, as well as other social | ||||||
4 | services that the Ombudsman Program considers appropriate; | ||||||
5 | (4) respond to inquiries and complaints relative to the | ||||||
6 | workers' compensation program; and | ||||||
7 | (5) serve as an information source for employees, | ||||||
8 | employers, medical, vocational, and rehabilitation | ||||||
9 | personnel, insurers, third-party administrators, and | ||||||
10 | self-insurers. | ||||||
11 | (b) Individuals within the Ombudsman Program may not appear | ||||||
12 | or intervene, as a party or otherwise, before the Commission on | ||||||
13 | behalf of an injured employee, employer, or medical provider. | ||||||
14 | This Section shall not construed as requiring or allowing legal | ||||||
15 | representation for an injured employee by the Ombudsman Program | ||||||
16 | in any proceeding for the Commission.
| ||||||
17 | (820 ILCS 305/14.3 new) | ||||||
18 | Sec. 14.3. WEAR Commission. | ||||||
19 | (a) There is created the Workers' Compensation Edit, | ||||||
20 | Alignment, and Reform Commission, which shall be known as the | ||||||
21 | WEAR Commission. The purpose of the WEAR Commission is to | ||||||
22 | develop a proposed recodification of the Workers' Compensation | ||||||
23 | Act that meets the following goals: | ||||||
24 | (1) to make this Act more accessible to laypeople | ||||||
25 | seeking benefits under this Act and employers seeking |
| |||||||
| |||||||
1 | insurance coverage for their responsibilities under this | ||||||
2 | Act; | ||||||
3 | (2) to aid the Commission, attorneys, and judges in | ||||||
4 | understanding and applying the provisions of this Act; | ||||||
5 | (3) to prevent disputes over interpretations of this | ||||||
6 | Act that can add additional costs to the function and | ||||||
7 | administration of the workers' compensation system; | ||||||
8 | (4) to reduce the size of each Section of this Act to | ||||||
9 | promote understanding, interpretation, and indexing of | ||||||
10 | this Act; | ||||||
11 | (5) to assist policymakers so that they can more easily | ||||||
12 | understand the implications of amendments to this Act that | ||||||
13 | may be proposed in the future; | ||||||
14 | (6) to replace outdated and obsolete language within | ||||||
15 | this Act; | ||||||
16 | (7) to limit the opportunity for lengthy and expensive | ||||||
17 | appeals due to confusion or contrary language within this | ||||||
18 | Act; and | ||||||
19 | (8) to meet the preceding objectives without changing | ||||||
20 | substantive law or disturbing established case law | ||||||
21 | precedent. | ||||||
22 | (b) The members of the WEAR Commission shall be as follows: | ||||||
23 | (1) One Senator appointed the President of the Senate; | ||||||
24 | (2) One Senator appointed by the Minority Leader of the | ||||||
25 | Senate; | ||||||
26 | (3) One Representative appointed by the Speaker of the |
| |||||||
| |||||||
1 | House of Representatives; | ||||||
2 | (4) One Representative appointed by the Minority | ||||||
3 | Leader of the House of Representatives; | ||||||
4 | (5) Four attorneys representing petitioners, one each | ||||||
5 | appointed by the President of the Senate, the Minority | ||||||
6 | Leader of the Senate, Speaker of the House of | ||||||
7 | Representatives, and Minority Leader of the House of | ||||||
8 | Representatives; and | ||||||
9 | (6) Four attorneys representing respondents, one each | ||||||
10 | appointed by the President of the Senate, Minority Leader | ||||||
11 | of the Senate, Speaker of the House of Representatives, and | ||||||
12 | Minority Leader of the House of Representatives. | ||||||
13 | The members of the WEAR Commission shall serve without | ||||||
14 | compensation. The Chairperson of the Illinois Workers' | ||||||
15 | Compensation Commission shall serve as Chairperson of the WEAR | ||||||
16 | Commission. | ||||||
17 | (c) The Illinois Workers' Compensation Commission, the | ||||||
18 | Workers' Compensation Insurance Compliance Unit, and the | ||||||
19 | Legislative Reference Bureau shall provide administrative | ||||||
20 | support for the WEAR Commission. | ||||||
21 | (d) The WEAR Commission shall present a report to the | ||||||
22 | General Assembly no later than July 1, 2017. This report shall | ||||||
23 | include a draft of proposed legislation for the reorganization | ||||||
24 | of the Workers' Compensation Act that accomplishes the goals | ||||||
25 | set forth by this Section. | ||||||
26 | (e) This Section is repealed on January 1, 2018.
|
| |||||||
| |||||||
1 | (820 ILCS 305/14.4 new) | ||||||
2 | Sec. 14.4. System improvements. | ||||||
3 | (a) By January 1, 2017, the Commission shall procure and | ||||||
4 | implement a computer system to replace its current outdated and | ||||||
5 | obsolete mainframe computer system. The Commission shall use | ||||||
6 | the funds allocated for this purpose as set forth in the | ||||||
7 | settlement agreement for the case entitled Illinois State | ||||||
8 | Chamber of Commerce v. Filan. | ||||||
9 | (b) The system procured by the Commission shall have all of | ||||||
10 | the following capabilities: | ||||||
11 | (1) require the electronic filing of claims before the | ||||||
12 | Commission, including the Application for Adjustment of | ||||||
13 | Claim and all subsequent filings by a petitioner or | ||||||
14 | respondent; the electronic filing fields for the | ||||||
15 | Application of Adjustment of Claim shall include the | ||||||
16 | following: | ||||||
17 | (i) for cases involving the State of Illinois, a | ||||||
18 | data field for the specific agency, department, | ||||||
19 | constitutional officer, board, or commission; | ||||||
20 | (ii) a data field for the petitioner to indicate | ||||||
21 | that the claim involves a repetitive injury; | ||||||
22 | (iii) a data field for the petitioner to indicate | ||||||
23 | that the claim involved an injury incurred when the | ||||||
24 | petitioner was traveling as part of his or her | ||||||
25 | employment; and |
| |||||||
| |||||||
1 | (iv) a data field for the petitioner to indicate | ||||||
2 | that he or she is pro se; | ||||||
3 | (2) allow for a searchable portal for injured workers | ||||||
4 | to access their cases status, including respondent or | ||||||
5 | respondent's attorney contact information, arbitrator | ||||||
6 | name, call location, and date; | ||||||
7 | (3) allow for the respondent to indicate the insurance | ||||||
8 | carrier of the employer, or third-party administrator of | ||||||
9 | the employer, if self-insured; | ||||||
10 | (4) allow for documents and exhibits to be uploaded | ||||||
11 | electronically; | ||||||
12 | (5) allow for the case history of each claim to be | ||||||
13 | viewed in a summary format arranged by the date of each | ||||||
14 | filing or hearing, which shall be available to the public; | ||||||
15 | (6) allow for the attorney of record for the | ||||||
16 | petitioner, if any, and the respondent to be clearly | ||||||
17 | indicated on any summary format, including the attorney who | ||||||
18 | actually tried or argued the case before an arbitrator or | ||||||
19 | Commissioner; | ||||||
20 | (7) allow for the decision of the arbitrator or the | ||||||
21 | Commission to be uploaded electronically; | ||||||
22 | (8) allow for the following data reports to be produced | ||||||
23 | from the electronic system: | ||||||
24 | (i) the total number of decisions by each | ||||||
25 | arbitrator
within any time period; | ||||||
26 | (ii) the total number of awards by injury type, |
| |||||||
| |||||||
1 | including repetitive injury or injuries suffered by | ||||||
2 | employees when traveling in the course of their | ||||||
3 | employment or alleged to be suffered by employees when | ||||||
4 | traveling in the course of their employment; | ||||||
5 | (iii) the penalties assessed against employers, | ||||||
6 | searchable by each employer; | ||||||
7 | (iv) the total number of decisions by each panel of | ||||||
8 | Commissioners; | ||||||
9 | (v) the total number of claims filed by State | ||||||
10 | employees within any time period; | ||||||
11 | (vi) the total number of new claims filed in each | ||||||
12 | arbitration zone; | ||||||
13 | (vii) the total number of Settlement Contract Lump | ||||||
14 | Sum Petitions; and | ||||||
15 | (viii) the industry types of employers against | ||||||
16 | whom claims are filed; | ||||||
17 | (9) allow for an electronic, searchable record of any | ||||||
18 | approved Settlement Contract Lump Petitions, including the | ||||||
19 | amount of such Settlement Contract Lump Sum Petitions, the | ||||||
20 | type of injury, and the attorneys representing each party, | ||||||
21 | if any, for such Settlement Contract Lump Sum Petitions; | ||||||
22 | (10) allow for the random assignment of cases by | ||||||
23 | arbitrator and to the Commission panels, if appealed; | ||||||
24 | (11) allow for the electronic transmission of the | ||||||
25 | record of proceedings before the Commission to be | ||||||
26 | transmitted to the circuit court in the event of an appeal |
| |||||||
| |||||||
1 | from the Commission; and | ||||||
2 | (12) ensure the confidentiality of all protected | ||||||
3 | information, including medical records. | ||||||
4 | (c) The Commission shall make all efforts to ensure that | ||||||
5 | parties practicing before the Commission, including injured | ||||||
6 | employees, are aware of the changes required by the procurement | ||||||
7 | of the computer system required by this Section.
| ||||||
8 | (820 ILCS 305/19) (from Ch. 48, par. 138.19)
| ||||||
9 | Sec. 19. Any disputed questions of law or fact shall be | ||||||
10 | determined
as herein provided.
| ||||||
11 | (a) It shall be the duty of the Commission upon | ||||||
12 | notification that
the parties have failed to reach an | ||||||
13 | agreement, to designate an Arbitrator.
| ||||||
14 | 1. Whenever any claimant misconceives his remedy and | ||||||
15 | files an
application for adjustment of claim under this Act | ||||||
16 | and it is
subsequently discovered, at any time before final | ||||||
17 | disposition of such
cause, that the claim for disability or | ||||||
18 | death which was the basis for
such application should | ||||||
19 | properly have been made under the Workers'
Occupational | ||||||
20 | Diseases Act, then the provisions of Section 19, paragraph
| ||||||
21 | (a-1) of the Workers' Occupational Diseases Act having | ||||||
22 | reference to such
application shall apply.
| ||||||
23 | 2. Whenever any claimant misconceives his remedy and | ||||||
24 | files an
application for adjustment of claim under the | ||||||
25 | Workers' Occupational
Diseases Act and it is subsequently |
| |||||||
| |||||||
1 | discovered, at any time before final
disposition of such | ||||||
2 | cause that the claim for injury or death which was
the | ||||||
3 | basis for such application should properly have been made | ||||||
4 | under this
Act, then the application so filed under the | ||||||
5 | Workers' Occupational
Diseases Act may be amended in form, | ||||||
6 | substance or both to assert claim
for such disability or | ||||||
7 | death under this Act and it shall be deemed to
have been so | ||||||
8 | filed as amended on the date of the original filing
| ||||||
9 | thereof, and such compensation may be awarded as is | ||||||
10 | warranted by the
whole evidence pursuant to this Act. When | ||||||
11 | such amendment is submitted,
further or additional | ||||||
12 | evidence may be heard by the Arbitrator or
Commission when | ||||||
13 | deemed necessary. Nothing in this Section contained
shall | ||||||
14 | be construed to be or permit a waiver of any provisions of | ||||||
15 | this
Act with reference to notice but notice if given shall | ||||||
16 | be deemed to be a
notice under the provisions of this Act | ||||||
17 | if given within the time
required herein.
| ||||||
18 | (b) The Arbitrator shall make such inquiries and | ||||||
19 | investigations as he or
they shall deem necessary and may | ||||||
20 | examine and inspect all books, papers,
records, places, or | ||||||
21 | premises relating to the questions in dispute and hear
such | ||||||
22 | proper evidence as the parties may submit.
| ||||||
23 | The hearings before the Arbitrator shall be held in the | ||||||
24 | vicinity where
the injury occurred after 10 days' notice of the | ||||||
25 | time and place of such
hearing shall have been given to each of | ||||||
26 | the parties or their attorneys
of record.
|
| |||||||
| |||||||
1 | The Arbitrator may find that the disabling condition is | ||||||
2 | temporary and has
not yet reached a permanent condition and may | ||||||
3 | order the payment of
compensation up to the date of the | ||||||
4 | hearing, which award shall be reviewable
and enforceable in the | ||||||
5 | same manner as other awards, and in no instance be a
bar to a | ||||||
6 | further hearing and determination of a further amount of | ||||||
7 | temporary
total compensation or of compensation for permanent | ||||||
8 | disability, but shall
be conclusive as to all other questions | ||||||
9 | except the nature and extent of said
disability.
| ||||||
10 | The decision of the Arbitrator shall be filed with the | ||||||
11 | Commission which
Commission shall immediately send to each | ||||||
12 | party or his attorney a copy of
such decision, together with a | ||||||
13 | notification of the time when it was filed.
As of the effective | ||||||
14 | date of this amendatory Act of the 94th General Assembly, all | ||||||
15 | decisions of the Arbitrator shall set forth
in writing findings | ||||||
16 | of fact and conclusions of law, separately stated, if requested | ||||||
17 | by either party.
Unless a petition for review is filed by | ||||||
18 | either party within 30 days after
the receipt by such party of | ||||||
19 | the copy of the decision and notification of
time when filed, | ||||||
20 | and unless such party petitioning for a review shall
within 35 | ||||||
21 | days after the receipt by him of the copy of the decision, file
| ||||||
22 | with the Commission either an agreed statement of the facts | ||||||
23 | appearing upon
the hearing before the Arbitrator, or if such
| ||||||
24 | party shall so elect a correct transcript of evidence of the | ||||||
25 | proceedings
at such hearings, then the decision shall become | ||||||
26 | the decision of the
Commission and in the absence of fraud |
| |||||||
| |||||||
1 | shall be conclusive.
The Petition for Review shall contain a | ||||||
2 | statement of the petitioning party's
specific exceptions to the | ||||||
3 | decision of the arbitrator. The jurisdiction
of the Commission | ||||||
4 | to review the decision of the arbitrator shall not be
limited | ||||||
5 | to the exceptions stated in the Petition for Review.
The | ||||||
6 | Commission, or any member thereof, may grant further time not | ||||||
7 | exceeding
30 days, in which to file such agreed statement or | ||||||
8 | transcript of
evidence. Such agreed statement of facts or | ||||||
9 | correct transcript of
evidence, as the case may be, shall be | ||||||
10 | authenticated by the signatures
of the parties or their | ||||||
11 | attorneys, and in the event they do not agree as
to the | ||||||
12 | correctness of the transcript of evidence it shall be | ||||||
13 | authenticated
by the signature of the Arbitrator designated by | ||||||
14 | the Commission.
| ||||||
15 | Whether the employee is working or not, if the employee is | ||||||
16 | not receiving or has not received medical, surgical, or | ||||||
17 | hospital services or other services or compensation as provided | ||||||
18 | in paragraph (a) of Section 8, or compensation as provided in | ||||||
19 | paragraph (b) of Section 8, the employee may at any time | ||||||
20 | petition for an expedited hearing by an Arbitrator on the issue | ||||||
21 | of whether or not he or she is entitled to receive payment of | ||||||
22 | the services or compensation. Provided the employer continues | ||||||
23 | to pay compensation pursuant to paragraph (b) of Section 8, the | ||||||
24 | employer may at any time petition for an expedited hearing on | ||||||
25 | the issue of whether or not the employee is entitled to receive | ||||||
26 | medical, surgical, or hospital services or other services or |
| |||||||
| |||||||
1 | compensation as provided in paragraph (a) of Section 8, or | ||||||
2 | compensation as provided in paragraph (b) of Section 8. When an | ||||||
3 | employer has petitioned for an expedited hearing, the employer | ||||||
4 | shall continue to pay compensation as provided in paragraph (b) | ||||||
5 | of Section 8 unless the arbitrator renders a decision that the | ||||||
6 | employee is not entitled to the benefits that are the subject | ||||||
7 | of the expedited hearing or unless the employee's treating | ||||||
8 | physician has released the employee to return to work at his or | ||||||
9 | her regular job with the employer or the employee actually | ||||||
10 | returns to work at any other job. If the arbitrator renders a | ||||||
11 | decision that the employee is not entitled to the benefits that | ||||||
12 | are the subject of the expedited hearing, a petition for review | ||||||
13 | filed by the employee shall receive the same priority as if the | ||||||
14 | employee had filed a petition for an expedited hearing by an | ||||||
15 | Arbitrator. Neither party shall be entitled to an expedited | ||||||
16 | hearing when the employee has returned to work and the sole | ||||||
17 | issue in dispute amounts to less than 12 weeks of unpaid | ||||||
18 | compensation pursuant to paragraph (b) of Section 8. | ||||||
19 | Expedited hearings shall have priority over all other | ||||||
20 | petitions and shall be heard by the Arbitrator and Commission | ||||||
21 | with all convenient speed. Any party requesting an expedited | ||||||
22 | hearing shall give notice of a request for an expedited hearing | ||||||
23 | under this paragraph. A copy of the Application for Adjustment | ||||||
24 | of Claim shall be attached to the notice. The Commission shall | ||||||
25 | adopt rules and procedures under which the final decision of | ||||||
26 | the Commission under this paragraph is filed not later than 180 |
| |||||||
| |||||||
1 | days from the date that the Petition for Review is filed with | ||||||
2 | the Commission. | ||||||
3 | Where 2 or more insurance carriers, private self-insureds, | ||||||
4 | or a group workers' compensation pool under Article V 3/4 of | ||||||
5 | the Illinois Insurance Code dispute coverage for the same | ||||||
6 | injury, any such insurance carrier, private self-insured, or | ||||||
7 | group workers' compensation pool may request an expedited | ||||||
8 | hearing pursuant to this paragraph to determine the issue of | ||||||
9 | coverage, provided coverage is the only issue in dispute and | ||||||
10 | all other issues are stipulated and agreed to and further | ||||||
11 | provided that all compensation benefits including medical | ||||||
12 | benefits pursuant to Section 8(a) continue to be paid to or on | ||||||
13 | behalf of petitioner. Any insurance carrier, private | ||||||
14 | self-insured, or group workers' compensation pool that is | ||||||
15 | determined to be liable for coverage for the injury in issue | ||||||
16 | shall reimburse any insurance carrier, private self-insured, | ||||||
17 | or group workers' compensation pool that has paid benefits to | ||||||
18 | or on behalf of petitioner for the injury.
| ||||||
19 | (b-1) If the employee is not receiving medical, surgical or | ||||||
20 | hospital
services as provided in paragraph (a) of Section 8 or | ||||||
21 | compensation as
provided in paragraph (b) of Section 8, the | ||||||
22 | employee, in accordance with
Commission Rules, may file a | ||||||
23 | petition for an emergency hearing by an
Arbitrator on the issue | ||||||
24 | of whether or not he is entitled to receive payment
of such | ||||||
25 | compensation or services as provided therein. Such petition | ||||||
26 | shall
have priority over all other petitions and shall be heard |
| |||||||
| |||||||
1 | by the Arbitrator
and Commission with all convenient speed.
| ||||||
2 | Such petition shall contain the following information and | ||||||
3 | shall be served
on the employer at least 15 days before it is | ||||||
4 | filed:
| ||||||
5 | (i) the date and approximate time of accident;
| ||||||
6 | (ii) the approximate location of the accident;
| ||||||
7 | (iii) a description of the accident;
| ||||||
8 | (iv) the nature of the injury incurred by the employee;
| ||||||
9 | (v) the identity of the person, if known, to whom the | ||||||
10 | accident was
reported and the date on which it was | ||||||
11 | reported;
| ||||||
12 | (vi) the name and title of the person, if known, | ||||||
13 | representing the
employer with whom the employee conferred | ||||||
14 | in any effort to obtain
compensation pursuant to paragraph | ||||||
15 | (b) of Section 8 of this Act or medical,
surgical or | ||||||
16 | hospital services pursuant to paragraph (a) of Section 8 of
| ||||||
17 | this Act and the date of such conference;
| ||||||
18 | (vii) a statement that the employer has refused to pay | ||||||
19 | compensation
pursuant to paragraph (b) of Section 8 of this | ||||||
20 | Act or for medical, surgical
or hospital services pursuant | ||||||
21 | to paragraph (a) of Section 8 of this Act;
| ||||||
22 | (viii) the name and address, if known, of each witness | ||||||
23 | to the accident
and of each other person upon whom the | ||||||
24 | employee will rely to support his
allegations;
| ||||||
25 | (ix) the dates of treatment related to the accident by | ||||||
26 | medical
practitioners, and the names and addresses of such |
| |||||||
| |||||||
1 | practitioners, including
the dates of treatment related to | ||||||
2 | the accident at any hospitals and the
names and addresses | ||||||
3 | of such hospitals, and a signed authorization
permitting | ||||||
4 | the employer to examine all medical records of all | ||||||
5 | practitioners
and hospitals named pursuant to this | ||||||
6 | paragraph;
| ||||||
7 | (x) a copy of a signed report by a medical | ||||||
8 | practitioner, relating to the
employee's current inability | ||||||
9 | to return to work because of the injuries
incurred as a | ||||||
10 | result of the accident or such other documents or | ||||||
11 | affidavits
which show that the employee is entitled to | ||||||
12 | receive compensation pursuant
to paragraph (b) of Section 8 | ||||||
13 | of this Act or medical, surgical or hospital
services | ||||||
14 | pursuant to paragraph (a) of Section 8 of this Act. Such | ||||||
15 | reports,
documents or affidavits shall state, if possible, | ||||||
16 | the history of the
accident given by the employee, and | ||||||
17 | describe the injury and medical
diagnosis, the medical | ||||||
18 | services for such injury which the employee has
received | ||||||
19 | and is receiving, the physical activities which the | ||||||
20 | employee
cannot currently perform as a result of any | ||||||
21 | impairment or disability due to
such injury, and the | ||||||
22 | prognosis for recovery;
| ||||||
23 | (xi) complete copies of any reports, records, | ||||||
24 | documents and affidavits
in the possession of the employee | ||||||
25 | on which the employee will rely to
support his allegations, | ||||||
26 | provided that the employer shall pay the
reasonable cost of |
| |||||||
| |||||||
1 | reproduction thereof;
| ||||||
2 | (xii) a list of any reports, records, documents and | ||||||
3 | affidavits which
the employee has demanded by subpoena and | ||||||
4 | on which he intends to
rely to support his allegations;
| ||||||
5 | (xiii) a certification signed by the employee or his | ||||||
6 | representative that
the employer has received the petition | ||||||
7 | with the required information 15
days before filing.
| ||||||
8 | Fifteen days after receipt by the employer of the petition | ||||||
9 | with the
required information the employee may file said | ||||||
10 | petition and required
information and shall serve notice of the | ||||||
11 | filing upon the employer. The
employer may file a motion | ||||||
12 | addressed to the sufficiency of the petition.
If an objection | ||||||
13 | has been filed to the sufficiency of the petition, the
| ||||||
14 | arbitrator shall rule on the objection within 2 working days. | ||||||
15 | If such an
objection is filed, the time for filing the final | ||||||
16 | decision of the
Commission as provided in this paragraph shall | ||||||
17 | be tolled until the
arbitrator has determined that the petition | ||||||
18 | is sufficient.
| ||||||
19 | The employer shall, within 15 days after receipt of the | ||||||
20 | notice that such
petition is filed, file with the Commission | ||||||
21 | and serve on the employee or
his representative a written | ||||||
22 | response to each claim set forth in the
petition, including the | ||||||
23 | legal and factual basis for each disputed
allegation and the | ||||||
24 | following information: (i) complete copies of any
reports, | ||||||
25 | records, documents and affidavits in the possession of the
| ||||||
26 | employer on which the employer intends to rely in support of |
| |||||||
| |||||||
1 | his response,
(ii) a list of any reports, records, documents | ||||||
2 | and affidavits which the
employer has demanded by subpoena and | ||||||
3 | on which the employer intends to rely
in support of his | ||||||
4 | response, (iii) the name and address of each witness on
whom | ||||||
5 | the employer will rely to support his response, and (iv) the | ||||||
6 | names and
addresses of any medical practitioners selected by | ||||||
7 | the employer pursuant to
Section 12 of this Act and the time | ||||||
8 | and place of any examination scheduled
to be made pursuant to | ||||||
9 | such Section.
| ||||||
10 | Any employer who does not timely file and serve a written | ||||||
11 | response
without good cause may not introduce any evidence to | ||||||
12 | dispute any claim of
the employee but may cross examine the | ||||||
13 | employee or any witness brought by
the employee and otherwise | ||||||
14 | be heard.
| ||||||
15 | No document or other evidence not previously identified by | ||||||
16 | either party
with the petition or written response, or by any | ||||||
17 | other means before the
hearing, may be introduced into evidence | ||||||
18 | without good cause.
If, at the hearing, material information is | ||||||
19 | discovered which was
not previously disclosed, the Arbitrator | ||||||
20 | may extend the time for closing
proof on the motion of a party | ||||||
21 | for a reasonable period of time which may
be more than 30 days. | ||||||
22 | No evidence may be introduced pursuant
to this paragraph as to | ||||||
23 | permanent disability. No award may be entered for
permanent | ||||||
24 | disability pursuant to this paragraph. Either party may | ||||||
25 | introduce
into evidence the testimony taken by deposition of | ||||||
26 | any medical practitioner.
|
| |||||||
| |||||||
1 | The Commission shall adopt rules, regulations and | ||||||
2 | procedures whereby the
final decision of the Commission is | ||||||
3 | filed not later than 90 days from the
date the petition for | ||||||
4 | review is filed but in no event later than 180 days from
the | ||||||
5 | date the petition for an emergency hearing is filed with the | ||||||
6 | Illinois Workers' Compensation
Commission.
| ||||||
7 | All service required pursuant to this paragraph (b-1) must | ||||||
8 | be by personal
service or by certified mail and with evidence | ||||||
9 | of receipt. In addition for
the purposes of this paragraph, all | ||||||
10 | service on the employer must be at the
premises where the | ||||||
11 | accident occurred if the premises are owned or operated
by the | ||||||
12 | employer. Otherwise service must be at the employee's principal
| ||||||
13 | place of employment by the employer. If service on the employer | ||||||
14 | is not
possible at either of the above, then service shall be | ||||||
15 | at the employer's
principal place of business. After initial | ||||||
16 | service in each case, service
shall be made on the employer's | ||||||
17 | attorney or designated representative.
| ||||||
18 | (c)(1) At a reasonable time in advance of and in connection | ||||||
19 | with the
hearing under Section 19(e) or 19(h), the Commission | ||||||
20 | may on its own motion
order an impartial physical or mental | ||||||
21 | examination of a petitioner whose
mental or physical condition | ||||||
22 | is in issue, when in the Commission's
discretion it appears | ||||||
23 | that such an examination will materially aid in the
just | ||||||
24 | determination of the case. The examination shall be made by a | ||||||
25 | member
or members of a panel of physicians chosen for their | ||||||
26 | special qualifications
by the Illinois State Medical Society. |
| |||||||
| |||||||
1 | The Commission shall establish
procedures by which a physician | ||||||
2 | shall be selected from such list.
| ||||||
3 | (2) Should the Commission at any time during the hearing | ||||||
4 | find that
compelling considerations make it advisable to have | ||||||
5 | an examination and
report at that time, the commission may in | ||||||
6 | its discretion so order.
| ||||||
7 | (3) A copy of the report of examination shall be given to | ||||||
8 | the Commission
and to the attorneys for the parties.
| ||||||
9 | (4) Either party or the Commission may call the examining | ||||||
10 | physician or
physicians to testify. Any physician so called | ||||||
11 | shall be subject to
cross-examination.
| ||||||
12 | (5) The examination shall be made, and the physician or | ||||||
13 | physicians, if
called, shall testify, without cost to the | ||||||
14 | parties. The Commission shall
determine the compensation and | ||||||
15 | the pay of the physician or physicians. The
compensation for | ||||||
16 | this service shall not exceed the usual and customary amount
| ||||||
17 | for such service.
| ||||||
18 | (6) The fees and payment thereof of all attorneys and | ||||||
19 | physicians for
services authorized by the Commission under this | ||||||
20 | Act shall, upon request
of either the employer or the employee | ||||||
21 | or the beneficiary affected, be
subject to the review and | ||||||
22 | decision of the Commission.
| ||||||
23 | (d) If any employee shall persist in insanitary or | ||||||
24 | injurious
practices which tend to either imperil or retard his | ||||||
25 | recovery or shall
refuse to submit to such medical, surgical, | ||||||
26 | or hospital treatment as is
reasonably essential to promote his |
| |||||||
| |||||||
1 | recovery, the Commission may, in its
discretion, reduce or | ||||||
2 | suspend the compensation of any such injured
employee. However, | ||||||
3 | when an employer and employee so agree in writing,
the | ||||||
4 | foregoing provision shall not be construed to authorize the
| ||||||
5 | reduction or suspension of compensation of an employee who is | ||||||
6 | relying in
good faith, on treatment by prayer or spiritual | ||||||
7 | means alone, in
accordance with the tenets and practice of a | ||||||
8 | recognized church or
religious denomination, by a duly | ||||||
9 | accredited practitioner thereof.
| ||||||
10 | (e) This paragraph shall apply to all hearings before the | ||||||
11 | Commission.
Such hearings may be held in its office or | ||||||
12 | elsewhere as the Commission
may deem advisable. The taking of | ||||||
13 | testimony on such hearings may be had
before any member of the | ||||||
14 | Commission. If a petition for review and agreed
statement of | ||||||
15 | facts or transcript of evidence is filed, as provided herein,
| ||||||
16 | the Commission shall promptly review the decision of the | ||||||
17 | Arbitrator and all
questions of law or fact which appear from | ||||||
18 | the statement of facts or
transcript of evidence.
| ||||||
19 | In all cases in which the hearing before the arbitrator is | ||||||
20 | held after
December 18, 1989, no additional evidence shall be | ||||||
21 | introduced by the
parties before the Commission on review of | ||||||
22 | the decision of the Arbitrator.
In reviewing decisions of an | ||||||
23 | arbitrator the Commission shall award such
temporary | ||||||
24 | compensation, permanent compensation and other payments as are
| ||||||
25 | due under this Act. The Commission shall file in its office its | ||||||
26 | decision
thereon, and shall immediately send to each party or |
| |||||||
| |||||||
1 | his attorney a copy of
such decision and a notification of the | ||||||
2 | time when it was filed. Decisions
shall be filed within 60 days | ||||||
3 | after the Statement of Exceptions and
Supporting Brief and | ||||||
4 | Response thereto are required to be filed or oral
argument | ||||||
5 | whichever is later.
| ||||||
6 | In the event either party requests oral argument, such | ||||||
7 | argument shall be
had before a panel of 3 members of the | ||||||
8 | Commission (or before all available
members pursuant to the | ||||||
9 | determination of 7 members of the Commission that
such argument | ||||||
10 | be held before all available members of the Commission)
| ||||||
11 | pursuant to the rules and regulations of the Commission. A | ||||||
12 | panel of 3
members, which shall be comprised of not more than | ||||||
13 | one representative
citizen of the employing class and not more | ||||||
14 | than one representative citizen
of the employee class, shall | ||||||
15 | hear the argument; provided that if all the
issues in dispute | ||||||
16 | are solely the nature and extent of the permanent partial
| ||||||
17 | disability, if any, a majority of the panel may deny the | ||||||
18 | request for such
argument and such argument shall not be held; | ||||||
19 | and provided further that 7
members of the Commission may | ||||||
20 | determine that the argument be held before
all available | ||||||
21 | members of the Commission. A decision of the Commission
shall | ||||||
22 | be approved by a majority of Commissioners present at such | ||||||
23 | hearing if
any; provided, if no such hearing is held, a | ||||||
24 | decision of the Commission
shall be approved by a majority of a | ||||||
25 | panel of 3 members of the Commission
as described in this | ||||||
26 | Section. The Commission shall give 10 days' notice to
the |
| |||||||
| |||||||
1 | parties or their attorneys of the time and place of such taking | ||||||
2 | of
testimony and of such argument.
| ||||||
3 | In any case the Commission in its decision may find | ||||||
4 | specially
upon any question or questions of law or fact which | ||||||
5 | shall be submitted
in writing by either party whether ultimate | ||||||
6 | or otherwise;
provided that on issues other than nature and | ||||||
7 | extent of the disability,
if any, the Commission in its | ||||||
8 | decision shall find specially upon any
question or questions of | ||||||
9 | law or fact, whether ultimate or otherwise,
which are submitted | ||||||
10 | in writing by either party; provided further that
not more than | ||||||
11 | 5 such questions may be submitted by either party. Any
party | ||||||
12 | may, within 20 days after receipt of notice of the Commission's
| ||||||
13 | decision, or within such further time, not exceeding 30 days, | ||||||
14 | as the
Commission may grant, file with the Commission either an | ||||||
15 | agreed
statement of the facts appearing upon the hearing, or, | ||||||
16 | if such party
shall so elect, a correct transcript of evidence | ||||||
17 | of the additional
proceedings presented before the Commission, | ||||||
18 | in which report the party
may embody a correct statement of | ||||||
19 | such other proceedings in the case as
such party may desire to | ||||||
20 | have reviewed, such statement of facts or
transcript of | ||||||
21 | evidence to be authenticated by the signature of the
parties or | ||||||
22 | their attorneys, and in the event that they do not agree,
then | ||||||
23 | the authentication of such transcript of evidence shall be by | ||||||
24 | the
signature of any member of the Commission.
| ||||||
25 | If a reporter does not for any reason furnish a transcript | ||||||
26 | of the
proceedings before the Arbitrator in any case for use on |
| |||||||
| |||||||
1 | a hearing for
review before the Commission, within the | ||||||
2 | limitations of time as fixed in
this Section, the Commission | ||||||
3 | may, in its discretion, order a trial de
novo before the | ||||||
4 | Commission in such case upon application of either
party. The | ||||||
5 | applications for adjustment of claim and other documents in
the | ||||||
6 | nature of pleadings filed by either party, together with the
| ||||||
7 | decisions of the Arbitrator and of the Commission and the | ||||||
8 | statement of
facts or transcript of evidence hereinbefore | ||||||
9 | provided for in paragraphs
(b) and (c) shall be the record of | ||||||
10 | the proceedings of the Commission,
and shall be subject to | ||||||
11 | review as hereinafter provided.
| ||||||
12 | At the request of either party or on its own motion, the | ||||||
13 | Commission shall
set forth in writing the reasons for the | ||||||
14 | decision, including findings of
fact and conclusions of law | ||||||
15 | separately stated. The Commission shall by rule
adopt a format | ||||||
16 | for written decisions for the Commission and arbitrators.
The | ||||||
17 | written decisions shall be concise and shall succinctly state | ||||||
18 | the facts
and reasons for the decision. The Commission may | ||||||
19 | adopt in whole or in part,
the decision of the arbitrator as | ||||||
20 | the decision of the Commission. When the
Commission does so | ||||||
21 | adopt the decision of the arbitrator, it shall do so by
order. | ||||||
22 | Whenever the Commission adopts part of the arbitrator's | ||||||
23 | decision,
but not all, it shall include in the order the | ||||||
24 | reasons for not adopting all
of the arbitrator's decision. When | ||||||
25 | a majority of a panel, after
deliberation, has arrived at its | ||||||
26 | decision, the decision shall be filed as
provided in this |
| |||||||
| |||||||
1 | Section without unnecessary delay, and without regard to
the | ||||||
2 | fact that a member of the panel has expressed an intention to | ||||||
3 | dissent.
Any member of the panel may file a dissent. Any | ||||||
4 | dissent shall be filed no
later than 10 days after the decision | ||||||
5 | of the majority has been filed.
| ||||||
6 | Decisions rendered by the Commission and dissents, if any, | ||||||
7 | shall be
published together by the Commission. The conclusions | ||||||
8 | of law set out in
such decisions shall be regarded as | ||||||
9 | precedents by arbitrators for the purpose
of achieving a more | ||||||
10 | uniform administration of this Act.
| ||||||
11 | (f) The decision of the Commission acting within its | ||||||
12 | powers,
according to the provisions of paragraph (e) of this | ||||||
13 | Section shall, in
the absence of fraud, be conclusive unless | ||||||
14 | reviewed as in this paragraph
hereinafter provided. However, | ||||||
15 | the Arbitrator or the Commission may on
his or its own motion, | ||||||
16 | or on the motion of either party, correct any
clerical error or | ||||||
17 | errors in computation within 15 days after the date of
receipt | ||||||
18 | of any award by such Arbitrator or any decision on review of | ||||||
19 | the
Commission and shall have the power to recall the original | ||||||
20 | award on
arbitration or decision on review, and issue in lieu | ||||||
21 | thereof such
corrected award or decision. Where such correction | ||||||
22 | is made the time for
review herein specified shall begin to run | ||||||
23 | from the date of
the receipt of the corrected award or | ||||||
24 | decision.
| ||||||
25 | (1) Except in cases of claims against the State of | ||||||
26 | Illinois other than those claims under Section 18.1, in
|
| |||||||
| |||||||
1 | which case the decision of the Commission shall not be | ||||||
2 | subject to
judicial review, the Circuit Court of the county | ||||||
3 | where any of the
parties defendant may be found, or if none | ||||||
4 | of the parties defendant can
be found in this State then | ||||||
5 | the Circuit Court of the county where the
accident | ||||||
6 | occurred, shall by summons to the Commission have
power to | ||||||
7 | review all questions of law and fact presented by such | ||||||
8 | record.
| ||||||
9 | A proceeding for review shall be commenced within 20 | ||||||
10 | days of
the receipt of notice of the decision of the | ||||||
11 | Commission. The summons shall
be issued by the clerk of | ||||||
12 | such court upon written request returnable on a
designated | ||||||
13 | return day, not less than 10 or more than 60 days from the | ||||||
14 | date
of issuance thereof, and the written request shall | ||||||
15 | contain the last known
address of other parties in interest | ||||||
16 | and their attorneys of record who are
to be served by | ||||||
17 | summons. Service upon any member of the Commission or the
| ||||||
18 | Secretary or the Assistant Secretary thereof shall be | ||||||
19 | service upon the
Commission, and service upon other parties | ||||||
20 | in interest and their attorneys
of record shall be by | ||||||
21 | summons, and such service shall be made upon the
Commission | ||||||
22 | and other parties in interest by mailing notices of the
| ||||||
23 | commencement of the proceedings and the return day of the | ||||||
24 | summons to the
office of the Commission and to the last | ||||||
25 | known place of residence of other
parties in interest or | ||||||
26 | their attorney or attorneys of record. The clerk of
the |
| |||||||
| |||||||
1 | court issuing the summons shall on the day of issue mail | ||||||
2 | notice of the
commencement of the proceedings which shall | ||||||
3 | be done by mailing a copy of
the summons to the office of | ||||||
4 | the Commission, and a copy of the summons to
the other | ||||||
5 | parties in interest or their attorney or attorneys of | ||||||
6 | record and
the clerk of the court shall make certificate | ||||||
7 | that he has so sent said
notices in pursuance of this | ||||||
8 | Section, which shall be evidence of service on
the | ||||||
9 | Commission and other parties in interest.
| ||||||
10 | The Commission shall not be required to certify the | ||||||
11 | record of their
proceedings to the Circuit Court, unless | ||||||
12 | the party commencing the
proceedings for review in the | ||||||
13 | Circuit Court as above provided, shall file with the | ||||||
14 | Commission notice of intent to file for review in Circuit | ||||||
15 | Court. It shall be the duty
of the Commission upon such | ||||||
16 | filing of notice of intent to file for review in the | ||||||
17 | Circuit Court to prepare a true and correct
copy of such | ||||||
18 | testimony and a true and correct copy of all other matters
| ||||||
19 | contained in such record and certified to by the Secretary | ||||||
20 | or Assistant
Secretary thereof. The changes made to this | ||||||
21 | subdivision (f)(1) by this amendatory Act of the 98th | ||||||
22 | General Assembly apply to any Commission decision entered | ||||||
23 | after the effective date of this amendatory Act of the 98th | ||||||
24 | General Assembly.
| ||||||
25 | No request for a summons
may be filed and no summons | ||||||
26 | shall issue unless the party seeking to review
the decision |
| |||||||
| |||||||
1 | of the Commission shall exhibit to the clerk of the Circuit
| ||||||
2 | Court proof of filing with the Commission of the notice of | ||||||
3 | the intent to file for review in the Circuit Court or an | ||||||
4 | affidavit
of the attorney setting forth that notice of | ||||||
5 | intent to file for review in the Circuit Court has been | ||||||
6 | given in writing to the Secretary or Assistant Secretary of | ||||||
7 | the Commission.
| ||||||
8 | (2) No such summons shall issue unless the one against | ||||||
9 | whom the
Commission shall have rendered an award for the | ||||||
10 | payment of money shall upon
the filing of his written | ||||||
11 | request for such summons file with the clerk of
the court a | ||||||
12 | bond conditioned that if he shall not successfully
| ||||||
13 | prosecute the review, he will pay the award and the costs | ||||||
14 | of the
proceedings in the courts. The amount of the bond | ||||||
15 | shall be fixed by any
member of the Commission and the | ||||||
16 | surety or sureties of the bond shall be
approved by the | ||||||
17 | clerk of the court. The acceptance of the bond by the
clerk | ||||||
18 | of the court shall constitute evidence of his approval of | ||||||
19 | the bond.
| ||||||
20 | The State of Illinois, including its constitutional | ||||||
21 | officers, boards, commissions, agencies, public | ||||||
22 | institutions of higher learning, and funds administered by | ||||||
23 | the Treasurer ex officio, and every Every county, city, | ||||||
24 | town, township, incorporated village, school
district, | ||||||
25 | body politic or municipal corporation against whom the
| ||||||
26 | Commission shall have rendered an award for the payment of |
| |||||||
| |||||||
1 | money shall
not be required to file a bond to secure the | ||||||
2 | payment of the award and
the costs of the proceedings in | ||||||
3 | the court to authorize the court to
issue such summons.
| ||||||
4 | The court may confirm or set aside the decision of the | ||||||
5 | Commission. If
the decision is set aside and the facts | ||||||
6 | found in the proceedings before
the Commission are | ||||||
7 | sufficient, the court may enter such decision as is
| ||||||
8 | justified by law, or may remand the cause to the Commission | ||||||
9 | for further
proceedings and may state the questions | ||||||
10 | requiring further hearing, and
give such other | ||||||
11 | instructions as may be proper. Appeals shall be taken
to | ||||||
12 | the Appellate Court in accordance
with Supreme Court Rules | ||||||
13 | 22(g) and 303. Appeals
shall be taken from the Appellate
| ||||||
14 | Court to the Supreme Court in accordance with Supreme Court | ||||||
15 | Rule 315.
| ||||||
16 | It shall be the duty of the clerk of any court | ||||||
17 | rendering a decision
affecting or affirming an award of the | ||||||
18 | Commission to promptly furnish
the Commission with a copy | ||||||
19 | of such decision, without charge.
| ||||||
20 | The decision of a majority of the members of the panel | ||||||
21 | of the Commission,
shall be considered the decision of the | ||||||
22 | Commission.
| ||||||
23 | (g) Except in the case of a claim against the State of | ||||||
24 | Illinois,
either party may present a certified copy of the | ||||||
25 | award of the
Arbitrator, or a certified copy of the decision of | ||||||
26 | the Commission when
the same has become final, when no |
| |||||||
| |||||||
1 | proceedings for review are pending,
providing for the payment | ||||||
2 | of compensation according to this Act, to the
Circuit Court of | ||||||
3 | the county in which such accident occurred or either of
the | ||||||
4 | parties are residents, whereupon the court shall enter a | ||||||
5 | judgment
in accordance therewith. In a case where the employer | ||||||
6 | refuses to pay
compensation according to such final award or | ||||||
7 | such final decision upon
which such judgment is entered the | ||||||
8 | court shall in entering judgment
thereon, tax as costs against | ||||||
9 | him the reasonable costs and attorney fees
in the arbitration | ||||||
10 | proceedings and in the court entering the judgment
for the | ||||||
11 | person in whose favor the judgment is entered, which judgment
| ||||||
12 | and costs taxed as therein provided shall, until and unless set | ||||||
13 | aside,
have the same effect as though duly entered in an action | ||||||
14 | duly tried and
determined by the court, and shall with like | ||||||
15 | effect, be entered and
docketed. The Circuit Court shall have | ||||||
16 | power at any time upon
application to make any such judgment | ||||||
17 | conform to any modification
required by any subsequent decision | ||||||
18 | of the Supreme Court upon appeal, or
as the result of any | ||||||
19 | subsequent proceedings for review, as provided in
this Act.
| ||||||
20 | Judgment shall not be entered until 15 days' notice of the | ||||||
21 | time and
place of the application for the entry of judgment | ||||||
22 | shall be served upon
the employer by filing such notice with | ||||||
23 | the Commission, which Commission
shall, in case it has on file | ||||||
24 | the address of the employer or the name
and address of its | ||||||
25 | agent upon whom notices may be served, immediately
send a copy | ||||||
26 | of the notice to the employer or such designated agent.
|
| |||||||
| |||||||
1 | (h) An agreement or award under this Act providing for | ||||||
2 | compensation
in installments, may at any time within 18 months | ||||||
3 | after such agreement
or award be reviewed by the Commission at | ||||||
4 | the request of either the
employer or the employee, on the | ||||||
5 | ground that the disability of the
employee has subsequently | ||||||
6 | recurred, increased, diminished or ended.
| ||||||
7 | However, as to accidents occurring subsequent to July 1, | ||||||
8 | 1955, which
are covered by any agreement or award under this | ||||||
9 | Act providing for
compensation in installments made as a result | ||||||
10 | of such accident, such
agreement or award may at any time | ||||||
11 | within 30 months, or 60 months in the case of an award under | ||||||
12 | Section 8(d)1, after such agreement
or award be reviewed by the | ||||||
13 | Commission at the request of either the
employer or the | ||||||
14 | employee on the ground that the disability of the
employee has | ||||||
15 | subsequently recurred, increased, diminished or ended.
| ||||||
16 | On such review, compensation payments may be | ||||||
17 | re-established,
increased, diminished or ended. The Commission | ||||||
18 | shall give 15 days'
notice to the parties of the hearing for | ||||||
19 | review. Any employee, upon any
petition for such review being | ||||||
20 | filed by the employer, shall be entitled
to one day's notice | ||||||
21 | for each 100 miles necessary to be traveled by him in
attending | ||||||
22 | the hearing of the Commission upon the petition, and 3 days in
| ||||||
23 | addition thereto. Such employee shall, at the discretion of the
| ||||||
24 | Commission, also be entitled to 5 cents per mile necessarily | ||||||
25 | traveled by
him within the State of Illinois in attending such | ||||||
26 | hearing, not to
exceed a distance of 300 miles, to be taxed by |
| |||||||
| |||||||
1 | the Commission as costs
and deposited with the petition of the | ||||||
2 | employer.
| ||||||
3 | When compensation which is payable in accordance with an | ||||||
4 | award or
settlement contract approved by the Commission, is | ||||||
5 | ordered paid in a
lump sum by the Commission, no review shall | ||||||
6 | be had as in this paragraph
mentioned.
| ||||||
7 | (i) Each party, upon taking any proceedings or steps | ||||||
8 | whatsoever
before any Arbitrator, Commission or court, shall | ||||||
9 | file with the Commission
his address, or the name and address | ||||||
10 | of any agent upon whom all notices to
be given to such party | ||||||
11 | shall be served, either personally or by registered
mail, | ||||||
12 | addressed to such party or agent at the last address so filed | ||||||
13 | with
the Commission. In the event such party has not filed his | ||||||
14 | address, or the
name and address of an agent as above provided, | ||||||
15 | service of any notice may
be had by filing such notice with the | ||||||
16 | Commission.
| ||||||
17 | (j) Whenever in any proceeding testimony has been taken or | ||||||
18 | a final
decision has been rendered and after the taking of such | ||||||
19 | testimony or
after such decision has become final, the injured | ||||||
20 | employee dies, then in
any subsequent proceedings brought by | ||||||
21 | the personal representative or
beneficiaries of the deceased | ||||||
22 | employee, such testimony in the former
proceeding may be | ||||||
23 | introduced with the same force and effect as though
the witness | ||||||
24 | having so testified were present in person in such
subsequent | ||||||
25 | proceedings and such final decision, if any, shall be taken
as | ||||||
26 | final adjudication of any of the issues which are the same in |
| |||||||
| |||||||
1 | both
proceedings.
| ||||||
2 | (k) In case where there has been any unreasonable or | ||||||
3 | vexatious delay
of payment or intentional underpayment of | ||||||
4 | compensation, or proceedings
have been instituted or carried on | ||||||
5 | by the one liable to pay the
compensation, which do not present | ||||||
6 | a real controversy, but are merely
frivolous or for delay, then | ||||||
7 | the Commission may award compensation
additional to that | ||||||
8 | otherwise payable under this Act equal to 50% of the
amount | ||||||
9 | payable at the time of such award. Failure to pay compensation
| ||||||
10 | in accordance with the provisions of Section 8, paragraph (b) | ||||||
11 | of this
Act, shall be considered unreasonable delay.
| ||||||
12 | When determining whether this subsection (k) shall apply, | ||||||
13 | the
Commission shall consider whether an Arbitrator has | ||||||
14 | determined
that the claim is not compensable or whether the | ||||||
15 | employer has
made payments under Section 8(j). | ||||||
16 | (l) If the employee has made written demand for payment of
| ||||||
17 | benefits under Section 8(a) or Section 8(b), the employer shall
| ||||||
18 | have 14 days after receipt of the demand to set forth in
| ||||||
19 | writing the reason for the delay. In the case of demand for
| ||||||
20 | payment of medical benefits under Section 8(a), the time for
| ||||||
21 | the employer to respond shall not commence until the expiration
| ||||||
22 | of the allotted 30 days specified under Section 8.2(d). In case
| ||||||
23 | the employer or his or her insurance carrier shall without good | ||||||
24 | and
just cause fail, neglect, refuse, or unreasonably delay the
| ||||||
25 | payment of benefits under Section 8(a) or Section 8(b), the
| ||||||
26 | Arbitrator or the Commission shall allow to the employee
|
| |||||||
| |||||||
1 | additional compensation in the sum of $30 per day for each day
| ||||||
2 | that the benefits under Section 8(a) or Section 8(b) have been
| ||||||
3 | so withheld or refused, not to exceed $10,000.
A delay in | ||||||
4 | payment of 14 days or more
shall create a rebuttable | ||||||
5 | presumption of unreasonable delay.
| ||||||
6 | (m) If the commission finds that an accidental injury was | ||||||
7 | directly
and proximately caused by the employer's wilful | ||||||
8 | violation of a health
and safety standard under the Health and | ||||||
9 | Safety Act or the Occupational Safety and Health Act in force | ||||||
10 | at the time of the
accident, the arbitrator or the Commission | ||||||
11 | shall allow to the injured
employee or his dependents, as the | ||||||
12 | case may be, additional compensation
equal to 25% of the amount | ||||||
13 | which otherwise would be payable under the
provisions of this | ||||||
14 | Act exclusive of this paragraph. The additional
compensation | ||||||
15 | herein provided shall be allowed by an appropriate increase
in | ||||||
16 | the applicable weekly compensation rate.
| ||||||
17 | (n) After June 30, 1984, decisions of the Illinois Workers' | ||||||
18 | Compensation Commission
reviewing an award of an arbitrator of | ||||||
19 | the Commission shall draw interest
at a rate equal to the yield | ||||||
20 | on indebtedness issued by the United States
Government with a | ||||||
21 | 26-week maturity next previously auctioned on the day on
which | ||||||
22 | the decision is filed. Said rate of interest shall be set forth | ||||||
23 | in
the Arbitrator's Decision. Interest shall be drawn from the | ||||||
24 | date of the
arbitrator's award on all accrued compensation due | ||||||
25 | the employee through the
day prior to the date of payments. | ||||||
26 | However, when an employee appeals an
award of an Arbitrator or |
| |||||||
| |||||||
1 | the Commission, and the appeal results in no
change or a | ||||||
2 | decrease in the award, interest shall not further accrue from
| ||||||
3 | the date of such appeal.
| ||||||
4 | The employer or his insurance carrier may tender the | ||||||
5 | payments due under
the award to stop the further accrual of | ||||||
6 | interest on such award
notwithstanding the prosecution by | ||||||
7 | either party of review, certiorari,
appeal to the Supreme Court | ||||||
8 | or other steps to reverse, vacate or modify
the award.
| ||||||
9 | (o) By the 15th day of each month each insurer providing | ||||||
10 | coverage for
losses under this Act shall notify each insured | ||||||
11 | employer of any compensable
claim incurred during the preceding | ||||||
12 | month and the amounts paid or reserved
on the claim including a | ||||||
13 | summary of the claim and a brief statement of the
reasons for | ||||||
14 | compensability. A cumulative report of all claims incurred
| ||||||
15 | during a calendar year or continued from the previous year | ||||||
16 | shall be
furnished to the insured employer by the insurer | ||||||
17 | within 30 days after the
end of that calendar year.
| ||||||
18 | The insured employer may challenge, in proceeding before | ||||||
19 | the Commission,
payments made by the insurer without | ||||||
20 | arbitration and payments
made after a case is determined to be | ||||||
21 | noncompensable. If the Commission
finds that the case was not | ||||||
22 | compensable, the insurer shall purge its records
as to that | ||||||
23 | employer of any loss or expense associated with the claim, | ||||||
24 | reimburse
the employer for attorneys' fees arising from the | ||||||
25 | challenge and for any
payment required of the employer to the | ||||||
26 | Rate Adjustment Fund or the
Second Injury Fund, and may not |
| |||||||
| |||||||
1 | reflect the loss or expense for rate making
purposes. The | ||||||
2 | employee shall not be required to refund the challenged
| ||||||
3 | payment. The decision of the Commission may be reviewed in the | ||||||
4 | same manner
as in arbitrated cases. No challenge may be | ||||||
5 | initiated under this paragraph
more than 3 years after the | ||||||
6 | payment is made. An employer may waive the
right of challenge | ||||||
7 | under this paragraph on a case by case basis.
| ||||||
8 | (p) After filing an application for adjustment of claim but | ||||||
9 | prior to
the hearing on arbitration the parties may voluntarily | ||||||
10 | agree to submit such
application for adjustment of claim for | ||||||
11 | decision by an arbitrator under
this subsection (p) where such | ||||||
12 | application for adjustment of claim raises
only a dispute over | ||||||
13 | temporary total disability, permanent partial
disability or | ||||||
14 | medical expenses. Such agreement shall be in writing in such
| ||||||
15 | form as provided by the Commission. Applications for adjustment | ||||||
16 | of claim
submitted for decision by an arbitrator under this | ||||||
17 | subsection (p) shall
proceed according to rule as established | ||||||
18 | by the Commission. The Commission
shall promulgate rules | ||||||
19 | including, but not limited to, rules to ensure that
the parties | ||||||
20 | are adequately informed of their rights under this subsection
| ||||||
21 | (p) and of the voluntary nature of proceedings under this | ||||||
22 | subsection (p).
The findings of fact made by an arbitrator | ||||||
23 | acting within his or her powers
under this subsection (p) in | ||||||
24 | the absence of fraud shall be conclusive.
However, the | ||||||
25 | arbitrator may on his own motion, or the motion of either
| ||||||
26 | party, correct any clerical errors or errors in computation |
| |||||||
| |||||||
1 | within 15 days
after the date of receipt of such award of the | ||||||
2 | arbitrator
and shall have the power to recall the original | ||||||
3 | award on arbitration, and
issue in lieu thereof such corrected | ||||||
4 | award.
The decision of the arbitrator under this subsection (p) | ||||||
5 | shall be
considered the decision of the Commission and | ||||||
6 | proceedings for review of
questions of law arising from the | ||||||
7 | decision may be commenced by either party
pursuant to | ||||||
8 | subsection (f) of Section 19. The Advisory Board established
| ||||||
9 | under Section 13.1 shall compile a list of certified Commission
| ||||||
10 | arbitrators, each of whom shall be approved by at least 7 | ||||||
11 | members of the
Advisory Board. The chairman shall select 5 | ||||||
12 | persons from such list to
serve as arbitrators under this | ||||||
13 | subsection (p). By agreement, the parties
shall select one | ||||||
14 | arbitrator from among the 5 persons selected by the
chairman | ||||||
15 | except that if the parties do not agree on an arbitrator from
| ||||||
16 | among the 5 persons, the parties may, by agreement, select an | ||||||
17 | arbitrator of
the American Arbitration Association, whose fee | ||||||
18 | shall be paid by the State
in accordance with rules promulgated | ||||||
19 | by the Commission. Arbitration under
this subsection (p) shall | ||||||
20 | be voluntary.
| ||||||
21 | (Source: P.A. 97-18, eff. 6-28-11; 98-40, eff. 6-28-13; 98-874, | ||||||
22 | eff. 1-1-15 .)
| ||||||
23 | (820 ILCS 305/25.5)
| ||||||
24 | Sec. 25.5. Unlawful acts; penalties. | ||||||
25 | (a) It is unlawful for any person, company, corporation, |
| |||||||
| |||||||
1 | insurance carrier, healthcare provider, or other entity to: | ||||||
2 | (1) Intentionally present or cause to be presented any | ||||||
3 | false or
fraudulent claim for the payment of any workers' | ||||||
4 | compensation
benefit.
| ||||||
5 | (2) Intentionally make or cause to be made any false or
| ||||||
6 | fraudulent material statement or material representation | ||||||
7 | for the
purpose of obtaining or denying any workers' | ||||||
8 | compensation
benefit.
| ||||||
9 | (3) Intentionally make or cause to be made any false or
| ||||||
10 | fraudulent statements with regard to entitlement to | ||||||
11 | workers'
compensation benefits with the intent to prevent | ||||||
12 | an injured
worker from making a legitimate claim for any | ||||||
13 | workers'
compensation benefits.
| ||||||
14 | (4) Intentionally prepare or provide an invalid, | ||||||
15 | false, or
counterfeit certificate of insurance as proof of | ||||||
16 | workers'
compensation insurance.
| ||||||
17 | (5) Intentionally make or cause to be made any false or
| ||||||
18 | fraudulent material statement or material representation | ||||||
19 | for the
purpose of obtaining workers' compensation | ||||||
20 | insurance at less
than the proper rate for that insurance.
| ||||||
21 | (6) Intentionally make or cause to be made any false or
| ||||||
22 | fraudulent material statement or material representation | ||||||
23 | on an
initial or renewal self-insurance application or | ||||||
24 | accompanying
financial statement for the purpose of | ||||||
25 | obtaining self-insurance
status or reducing the amount of | ||||||
26 | security that may be required
to be furnished pursuant to |
| |||||||
| |||||||
1 | Section 4 of this Act.
| ||||||
2 | (7) Intentionally make or cause to be made any false or
| ||||||
3 | fraudulent material statement to the Illinois Workers' | ||||||
4 | Compensation Commission's Department of Insurance's
fraud | ||||||
5 | and insurance non-compliance unit in the course of an
| ||||||
6 | investigation of fraud or insurance non-compliance.
| ||||||
7 | (8) Intentionally assist, abet, solicit, or conspire | ||||||
8 | with any
person, company, or other entity to commit any of | ||||||
9 | the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) | ||||||
10 | of this subsection (a).
| ||||||
11 | (9) Intentionally present a bill or statement for the | ||||||
12 | payment for medical services that were not provided. | ||||||
13 | For the purposes of paragraphs (2), (3), (5), (6), (7), and | ||||||
14 | (9), the term "statement" includes any writing, notice, proof | ||||||
15 | of injury, bill for services, hospital or doctor records and | ||||||
16 | reports, or X-ray and test results.
| ||||||
17 | (b) Sentences for violations of subsection (a) are as | ||||||
18 | follows:
| ||||||
19 | (1) A violation in which the value of the property | ||||||
20 | obtained or attempted to be obtained is $300 or less is a | ||||||
21 | Class A misdemeanor. | ||||||
22 | (2) A violation in which the value of the property | ||||||
23 | obtained or attempted to be obtained is more than $300 but | ||||||
24 | not more than $10,000 is a Class 3 felony. | ||||||
25 | (3) A violation in which the value of the property | ||||||
26 | obtained or attempted to be obtained is more than $10,000 |
| |||||||
| |||||||
1 | but not more than $100,000 is a Class 2 felony. | ||||||
2 | (4) A violation in which the value of the property | ||||||
3 | obtained or attempted to be obtained is more than $100,000 | ||||||
4 | is a Class 1 felony. | ||||||
5 | (5) A person convicted under this Section shall be | ||||||
6 | ordered to pay monetary restitution to the insurance | ||||||
7 | company or self-insured entity or any other person for any | ||||||
8 | financial loss sustained as a result of a violation of this | ||||||
9 | Section, including any court costs and attorney fees. An | ||||||
10 | order of restitution also includes expenses incurred and | ||||||
11 | paid by the State of Illinois or an insurance company or | ||||||
12 | self-insured entity in connection with any medical | ||||||
13 | evaluation or treatment services. | ||||||
14 | For the purposes of this Section, where the exact value of | ||||||
15 | property obtained or attempted to be obtained is either not | ||||||
16 | alleged or is not specifically set by the terms of a policy of | ||||||
17 | insurance, the value of the property shall be the fair market | ||||||
18 | replacement value of the property claimed to be lost, the | ||||||
19 | reasonable costs of reimbursing a vendor or other claimant for | ||||||
20 | services to be rendered, or both. Notwithstanding the | ||||||
21 | foregoing, an insurance company, self-insured entity, or any | ||||||
22 | other person suffering financial loss sustained as a result of | ||||||
23 | violation of this Section may seek restitution, including court | ||||||
24 | costs and attorney's fees in a civil action in a court of | ||||||
25 | competent jurisdiction. | ||||||
26 | (c) The Illinois Workers' Compensation Commission |
| |||||||
| |||||||
1 | Department of Insurance shall establish a fraud and insurance | ||||||
2 | non-compliance unit responsible for investigating incidences | ||||||
3 | of fraud and insurance non-compliance pursuant to this Section. | ||||||
4 | The size of the staff of the unit shall be subject to | ||||||
5 | appropriation by the General Assembly. It shall be the duty of | ||||||
6 | the fraud and insurance non-compliance unit to determine the | ||||||
7 | identity of insurance carriers, employers, employees, or other | ||||||
8 | persons or entities who have violated the fraud and insurance | ||||||
9 | non-compliance provisions of this Section. The fraud and | ||||||
10 | insurance non-compliance unit shall report violations of the | ||||||
11 | fraud and insurance non-compliance provisions of this Section | ||||||
12 | to the Special Prosecutions Bureau of the Criminal Division of | ||||||
13 | the Office of the Attorney General or to the State's Attorney | ||||||
14 | of the county in which the offense allegedly occurred, either | ||||||
15 | of whom has the authority to prosecute violations under this | ||||||
16 | Section.
| ||||||
17 | With respect to the subject of any investigation being | ||||||
18 | conducted, the fraud and insurance non-compliance unit shall | ||||||
19 | have the general power of subpoena of the Department of | ||||||
20 | Insurance , including the authority to issue a subpoena to a | ||||||
21 | medical provider, pursuant to Section 8-802 of the Code of | ||||||
22 | Civil Procedure.
| ||||||
23 | (d) Any person may report allegations of insurance | ||||||
24 | non-compliance and fraud pursuant to this Section to the | ||||||
25 | Illinois Workers' Compensation Commission's Department of | ||||||
26 | Insurance's fraud and insurance non-compliance unit whose duty |
| |||||||
| |||||||
1 | it shall be to investigate the report. The unit shall notify | ||||||
2 | the Commission of reports of insurance non-compliance. Any | ||||||
3 | person reporting an allegation of insurance non-compliance or | ||||||
4 | fraud against either an employee or employer under this Section | ||||||
5 | must identify himself. Except as provided in this subsection | ||||||
6 | and in subsection (e), all reports shall remain confidential | ||||||
7 | except to refer an investigation to the Attorney General or | ||||||
8 | State's Attorney for prosecution or if the fraud and insurance | ||||||
9 | non-compliance unit's investigation reveals that the conduct | ||||||
10 | reported may be in violation of other laws or regulations of | ||||||
11 | the State of Illinois, the unit may report such conduct to the | ||||||
12 | appropriate governmental agency charged with administering | ||||||
13 | such laws and regulations. Any person who intentionally makes a | ||||||
14 | false report under this Section to the fraud and insurance | ||||||
15 | non-compliance unit is guilty of a Class A misdemeanor.
| ||||||
16 | (e) In order for the fraud and insurance non-compliance | ||||||
17 | unit to investigate a report of fraud related to an employee's | ||||||
18 | claim, (i) the employee must have filed with the Commission an | ||||||
19 | Application for Adjustment of Claim and the employee must have | ||||||
20 | either received or attempted to receive benefits under this Act | ||||||
21 | that are related to the reported fraud or (ii) the employee | ||||||
22 | must have made a written demand for the payment of benefits | ||||||
23 | that are related to the reported fraud. There shall be no | ||||||
24 | immunity, under this Act or otherwise, for any person who files | ||||||
25 | a false report or who files a report without good and just | ||||||
26 | cause. Confidentiality of medical information shall be |
| |||||||
| |||||||
1 | strictly maintained. Investigations that are not referred for | ||||||
2 | prosecution shall be destroyed upon the expiration of the | ||||||
3 | statute of limitations for the acts under investigation and | ||||||
4 | shall not be disclosed except that the person making the report | ||||||
5 | shall be notified that the investigation is being closed. It is | ||||||
6 | unlawful for any employer, insurance carrier, service | ||||||
7 | adjustment company, third party administrator, self-insured, | ||||||
8 | or similar entity to file or threaten to file a report of fraud | ||||||
9 | against an employee because of the exercise by the employee of | ||||||
10 | the rights and remedies granted to the employee by this Act.
| ||||||
11 | (e-5) The fraud and insurance non-compliance unit shall | ||||||
12 | procure and implement a system utilizing advanced analytics | ||||||
13 | inclusive of predictive modeling, data mining, social network | ||||||
14 | analysis, and scoring algorithms for the detection and | ||||||
15 | prevention of fraud, waste, and abuse on or before January 1, | ||||||
16 | 2012. The fraud and insurance non-compliance unit shall procure | ||||||
17 | this system using a request for proposals process governed by | ||||||
18 | the Illinois Procurement Code and rules adopted under that | ||||||
19 | Code. The fraud and insurance non-compliance unit shall provide | ||||||
20 | a report to the President of the Senate, Speaker of the House | ||||||
21 | of Representatives, Minority Leader of the House of | ||||||
22 | Representatives, Minority Leader of the Senate, Governor, | ||||||
23 | Chairman of the Commission, and Director of Insurance on or | ||||||
24 | before July 1, 2012 and annually thereafter detailing its | ||||||
25 | activities and providing recommendations regarding | ||||||
26 | opportunities for additional fraud waste and abuse detection |
| |||||||
| |||||||
1 | and prevention. | ||||||
2 | (f) Any person convicted of fraud related to workers' | ||||||
3 | compensation pursuant to this Section shall be subject to the | ||||||
4 | penalties prescribed in the Criminal Code of 2012 and shall be | ||||||
5 | ineligible to receive or retain any compensation, disability, | ||||||
6 | or medical benefits as defined in this Act if the compensation, | ||||||
7 | disability, or medical benefits were owed or received as a | ||||||
8 | result of fraud for which the recipient of the compensation, | ||||||
9 | disability, or medical benefit was convicted. This subsection | ||||||
10 | applies to accidental injuries or diseases that occur on or | ||||||
11 | after the effective date of this amendatory Act of the 94th | ||||||
12 | General Assembly.
| ||||||
13 | (g) Civil liability. Any person convicted of fraud who | ||||||
14 | knowingly obtains, attempts to obtain, or causes to be obtained | ||||||
15 | any benefits under this Act by the making of a false claim or | ||||||
16 | who knowingly misrepresents any material fact shall be civilly | ||||||
17 | liable to the payor of benefits or the insurer or the payor's | ||||||
18 | or insurer's subrogee or assignee in an amount equal to 3 times | ||||||
19 | the value of the benefits or insurance coverage wrongfully | ||||||
20 | obtained or twice the value of the benefits or insurance | ||||||
21 | coverage attempted to be obtained, plus reasonable attorney's | ||||||
22 | fees and expenses incurred by the payor or the payor's subrogee | ||||||
23 | or assignee who successfully brings a claim under this | ||||||
24 | subsection. This subsection applies to accidental injuries or | ||||||
25 | diseases that occur on or after the effective date of this | ||||||
26 | amendatory Act of the 94th General Assembly.
|
| ||||||||||||||||||||||||||
| ||||||||||||||||||||||||||
1 | (h) The fraud and insurance non-compliance unit shall | |||||||||||||||||||||||||
2 | submit a written report on an annual basis to the Chairman of | |||||||||||||||||||||||||
3 | the Commission, the Workers' Compensation Advisory Board, the | |||||||||||||||||||||||||
4 | General Assembly, the Governor, and the Attorney General by | |||||||||||||||||||||||||
5 | January 1 and July 1 of each year. This report shall include, | |||||||||||||||||||||||||
6 | at the minimum, the following information: | |||||||||||||||||||||||||
7 | (1) The number of allegations of insurance | |||||||||||||||||||||||||
8 | non-compliance and fraud reported to the fraud and | |||||||||||||||||||||||||
9 | insurance non-compliance unit. | |||||||||||||||||||||||||
10 | (2) The source of the reported allegations | |||||||||||||||||||||||||
11 | (individual, employer, or other). | |||||||||||||||||||||||||
12 | (3) The number of allegations investigated by the fraud | |||||||||||||||||||||||||
13 | and insurance non-compliance unit. | |||||||||||||||||||||||||
14 | (4) The number of criminal referrals made in accordance | |||||||||||||||||||||||||
15 | with this Section and the entity to which the referral was | |||||||||||||||||||||||||
16 | made. | |||||||||||||||||||||||||
17 | (5) All proceedings under this Section.
| |||||||||||||||||||||||||
18 | (Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)
| |||||||||||||||||||||||||
|