Bill Text: IL SB0162 | 2015-2016 | 99th General Assembly | Engrossed

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Bill Title: Amends the Illinois Antitrust Act. Makes a technical change in a Section concerning the short title of the Act.

Spectrum: Partisan Bill (Democrat 6-0)

Status: (Engrossed - Dead) 2015-08-05 - Referred to Rules Committee [SB0162 Detail]

Download: Illinois-2015-SB0162-Engrossed.html

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AN ACT concerning civil law.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Workers' Compensation Act is amended by
changing Sections 1, 8.1b, 8.2a, 14, and 25.5 and by adding
Sections 14.2, 14.3, and 14.4 as follows:
(820 ILCS 305/1) (from Ch. 48, par. 138.1)
Sec. 1. This Act may be cited as the Workers' Compensation
Act.
(a) The term "employer" as used in this Act means:
1. The State and each county, city, town, township,
incorporated village, school district, body politic, or
municipal corporation therein.
2. Every person, firm, public or private corporation,
including hospitals, public service, eleemosynary, religious
or charitable corporations or associations who has any person
in service or under any contract for hire, express or implied,
oral or written, and who is engaged in any of the enterprises
or businesses enumerated in Section 3 of this Act, or who at or
prior to the time of the accident to the employee for which
compensation under this Act may be claimed, has in the manner
provided in this Act elected to become subject to the
provisions of this Act, and who has not, prior to such

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accident, effected a withdrawal of such election in the manner
provided in this Act.
3. Any one engaging in any business or enterprise referred
to in subsections 1 and 2 of Section 3 of this Act who
undertakes to do any work enumerated therein, is liable to pay
compensation to his own immediate employees in accordance with
the provisions of this Act, and in addition thereto if he
directly or indirectly engages any contractor whether
principal or sub-contractor to do any such work, he is liable
to pay compensation to the employees of any such contractor or
sub-contractor unless such contractor or sub-contractor has
insured, in any company or association authorized under the
laws of this State to insure the liability to pay compensation
under this Act, or guaranteed his liability to pay such
compensation. With respect to any time limitation on the filing
of claims provided by this Act, the timely filing of a claim
against a contractor or subcontractor, as the case may be,
shall be deemed to be a timely filing with respect to all
persons upon whom liability is imposed by this paragraph.
In the event any such person pays compensation under this
subsection he may recover the amount thereof from the
contractor or sub-contractor, if any, and in the event the
contractor pays compensation under this subsection he may
recover the amount thereof from the sub-contractor, if any.
This subsection does not apply in any case where the
accident occurs elsewhere than on, in or about the immediate

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premises on which the principal has contracted that the work be
done.
4. Where an employer operating under and subject to the
provisions of this Act loans an employee to another such
employer and such loaned employee sustains a compensable
accidental injury in the employment of such borrowing employer
and where such borrowing employer does not provide or pay the
benefits or payments due such injured employee, such loaning
employer is liable to provide or pay all benefits or payments
due such employee under this Act and as to such employee the
liability of such loaning and borrowing employers is joint and
several, provided that such loaning employer is in the absence
of agreement to the contrary entitled to receive from such
borrowing employer full reimbursement for all sums paid or
incurred pursuant to this paragraph together with reasonable
attorneys' fees and expenses in any hearings before the
Illinois Workers' Compensation Commission or in any action to
secure such reimbursement. Where any benefit is provided or
paid by such loaning employer the employee has the duty of
rendering reasonable cooperation in any hearings, trials or
proceedings in the case, including such proceedings for
reimbursement.
Where an employee files an Application for Adjustment of
Claim with the Illinois Workers' Compensation Commission
alleging that his claim is covered by the provisions of the
preceding paragraph, and joining both the alleged loaning and

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borrowing employers, they and each of them, upon written demand
by the employee and within 7 days after receipt of such demand,
shall have the duty of filing with the Illinois Workers'
Compensation Commission a written admission or denial of the
allegation that the claim is covered by the provisions of the
preceding paragraph and in default of such filing or if any
such denial be ultimately determined not to have been bona fide
then the provisions of Paragraph K of Section 19 of this Act
shall apply.
An employer whose business or enterprise or a substantial
part thereof consists of hiring, procuring or furnishing
employees to or for other employers operating under and subject
to the provisions of this Act for the performance of the work
of such other employers and who pays such employees their
salary or wages notwithstanding that they are doing the work of
such other employers shall be deemed a loaning employer within
the meaning and provisions of this Section.
(b) The term "employee" as used in this Act means:
1. Every person in the service of the State, including
members of the General Assembly, members of the Commerce
Commission, members of the Illinois Workers' Compensation
Commission, and all persons in the service of the University of
Illinois, county, including deputy sheriffs and assistant
state's attorneys, city, town, township, incorporated village
or school district, body politic, or municipal corporation
therein, whether by election, under appointment or contract of

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hire, express or implied, oral or written, including all
members of the Illinois National Guard while on active duty in
the service of the State, and all probation personnel of the
Juvenile Court appointed pursuant to Article VI of the Juvenile
Court Act of 1987, and including any official of the State, any
county, city, town, township, incorporated village, school
district, body politic or municipal corporation therein except
any duly appointed member of a police department in any city
whose population exceeds 500,000 according to the last Federal
or State census, and except any member of a fire insurance
patrol maintained by a board of underwriters in this State. A
duly appointed member of a fire department in any city, the
population of which exceeds 500,000 according to the last
federal or State census, is an employee under this Act only
with respect to claims brought under paragraph (c) of Section
8.
One employed by a contractor who has contracted with the
State, or a county, city, town, township, incorporated village,
school district, body politic or municipal corporation
therein, through its representatives, is not considered as an
employee of the State, county, city, town, township,
incorporated village, school district, body politic or
municipal corporation which made the contract.
2. Every person in the service of another under any
contract of hire, express or implied, oral or written,
including persons whose employment is outside of the State of

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Illinois where the contract of hire is made within the State of
Illinois, persons whose employment results in fatal or
non-fatal injuries within the State of Illinois where the
contract of hire is made outside of the State of Illinois, and
persons whose employment is principally localized within the
State of Illinois, regardless of the place of the accident or
the place where the contract of hire was made, and including
aliens, and minors who, for the purpose of this Act are
considered the same and have the same power to contract,
receive payments and give quittances therefor, as adult
employees.
3. Every sole proprietor and every partner of a business
may elect to be covered by this Act.
An employee or his dependents under this Act who shall have
a cause of action by reason of any injury, disablement or death
arising out of and in the course of his employment may elect to
pursue his remedy in the State where injured or disabled, or in
the State where the contract of hire is made, or in the State
where the employment is principally localized.
However, any employer may elect to provide and pay
compensation to any employee other than those engaged in the
usual course of the trade, business, profession or occupation
of the employer by complying with Sections 2 and 4 of this Act.
Employees are not included within the provisions of this Act
when excluded by the laws of the United States relating to
liability of employers to their employees for personal injuries

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where such laws are held to be exclusive.
The term "employee" does not include persons performing
services as real estate broker, broker-salesman, or salesman
when such persons are paid by commission only.
(c) "Commission" means the Industrial Commission created
by Section 5 of "The Civil Administrative Code of Illinois",
approved March 7, 1917, as amended, or the Illinois Workers'
Compensation Commission created by Section 13 of this Act.
(d) For the purposes of this subsection (d):
"In the course of employment" means the time, place, and
circumstances surrounding the accidental injuries.
"Arising out of the employment" means causal connection. It
must be shown that the injury had its origin in some risk
connected with, or incidental to, the employment so as to
create a causal connection between the employment and the
accidental injuries. An injury arises out of the employment if,
at the time of the occurrence, the employee was performing acts
he or she was instructed to perform by his or her employer,
acts which he or she had a common law or statutory duty to
perform, or acts which the employee might reasonably be
expected to perform incident to his or her assigned duties. A
risk is incidental to the employment where it belongs to or is
connected with what an employee has to do in fulfilling his or
her duties.
To obtain compensation under this Act, an employee bears
the burden of showing, by a preponderance of the evidence, that

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he or she has sustained accidental injuries arising out of and
in the course of the employment. Except as provided in
subsection (e) of this Section, accidental injuries sustained
while traveling to or from work do not arise out of and in the
course of employment.
(e) Where an employee is required to travel away from his
or her employer's premises in order to perform his or her job,
the traveling employee's accidental injuries arise out of his
or her employment, and are in the course of his or her
employment, when the conduct in which he or she was engaged at
the time of the injury is reasonable and when that conduct
might have been anticipated or foreseen by the employer.
Accidental injuries while traveling do not occur in the course
of employment if the accident occurs during a purely personal
deviation or personal errand unless such deviation or errand is
insubstantial.
In determining whether an employee is required to travel
away from his or her employer's premises in order to perform
his or her job, along with all other relevant factors, the
following factors may be considered: whether the employer had
knowledge that the employee may be required to travel to
perform the job; whether the employer furnished any mode of
transportation to or from the employee; whether the employee
received or the employer paid or agreed to pay any remuneration
or reimbursement for costs or expenses of any form of travel;
whether the employer in any way directed the course or method

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of travel; whether the employer in any way assisted the
employee in making any travel arrangements; whether the
employer furnished lodging or in any way reimbursed the
employee for lodging; or whether the employer received any
benefit from the employee traveling.
(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
eff. 7-13-12.)
(820 ILCS 305/8.1b)
Sec. 8.1b. Determination of permanent partial disability.
For accidental injuries that occur on or after September 1,
2011, permanent partial disability shall be established using
the following criteria:
(a) A physician licensed to practice medicine in all of its
branches preparing a permanent partial disability impairment
report shall report the level of impairment in writing. The
report shall include an evaluation of medically defined and
professionally appropriate measurements of impairment that
include, but are not limited to: loss of range of motion; loss
of strength; measured atrophy of tissue mass consistent with
the injury; and any other measurements that establish the
nature and extent of the impairment. The most current edition
of the American Medical Association's "Guides to the Evaluation
of Permanent Impairment" shall be used by the physician in
determining the level of impairment.
(b) In determining the level of permanent partial

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disability, the Commission shall base its determination on the
following factors: (i) the reported level of impairment
pursuant to subsection (a), if such report exists; (ii) the
occupation of the injured employee; (iii) the age of the
employee at the time of the injury; (iv) the employee's future
earning capacity; and (v) evidence of disability corroborated
by the treating medical records or examination under Section 12
of this Act. No single enumerated factor shall be the sole
determinant of disability. In determining the level of
disability, the relevance and weight of any factors used in
addition to the level of impairment as reported by the
physician must be explained in a written order.
(c) A report of impairment prepared pursuant to subsection
(a) is not required for an arbitrator or the Commission to make
an award for permanent partial disability or permanent total
disability benefits or any award for benefits under subsection
(c) of Section 8 or subsection (d) of Section 8 of this Act or
to approve a Settlement Contract Lump Sum Petition.
(Source: P.A. 97-18, eff. 6-28-11.)
(820 ILCS 305/8.2a)
Sec. 8.2a. Electronic claims.
(a) The Director of Insurance shall adopt rules to do all
of the following:
(1) Ensure that all health care providers and
facilities submit medical bills for payment on

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standardized forms.
(2) Require acceptance by employers and insurers of
electronic claims for payment of medical services.
(3) Ensure confidentiality of medical information
submitted on electronic claims for payment of medical
services.
(4) Ensure that the rules establishing electronic
claims include a specific enforcement mechanism to ensure
compliance with these rules.
(5) Ensure that health care providers have at least 15
business days to comply with records requested by employers
and insurers for the authorization of the payment of
workers' compensation claims.
(6) Ensure that health care providers are responsible
for supplying only those medical records pertaining to the
provider's own claims that are minimally necessary under
the federal Health Insurance Portability and
Accountability Act of 1996.
(b) To the extent feasible, standards adopted pursuant to
subdivision (a) shall be consistent with existing standards
under the federal Health Insurance Portability and
Accountability Act of 1996 and standards adopted under the
Illinois Health Information Exchange and Technology Act.
(c) The rules requiring employers and insurers to accept
electronic claims for payment of medical services shall be
proposed on or before May 31, 2016, January 1, 2012, and shall

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

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(c) medical lectures by specialists in areas such as
orthopedics, ophthalmology, psychiatry, rehabilitation
counseling;
(d) orientation to each operational unit of the
Illinois Workers' Compensation Commission;
(e) observation of experienced arbitrators conducting
hearings of cases, combined with the opportunity to discuss
evidence presented and rulings made;
(f) the use of hypothetical cases requiring the trainee
to issue judgments as a means to evaluating knowledge and
writing ability;
(g) writing skills;
(h) professional and ethical standards pursuant to
Section 1.1 of this Act;
(i) detection of workers' compensation fraud and
reporting obligations of Commission employees and
appointees;
(j) standards of evidence-based medical treatment and
best practices for measuring and improving quality and
health care outcomes in the workers' compensation system,
including but not limited to the use of the American
Medical Association's "Guides to the Evaluation of
Permanent Impairment" and the practice of utilization
review; and
(k) substantive and procedural aspects of coal
workers' pneumoconiosis (black lung) cases.

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A formal and ongoing professional development program
including, but not limited to, the above-noted areas shall be
implemented to keep arbitrators informed of recent
developments and issues and to assist them in maintaining and
enhancing their professional competence. Each arbitrator shall
complete 20 hours of training in the above-noted areas during
every 2 years such arbitrator shall remain in office.
Each arbitrator shall devote full time to his or her duties
and shall serve when assigned as an acting Commissioner when a
Commissioner is unavailable in accordance with the provisions
of Section 13 of this Act. Any arbitrator who is an
attorney-at-law shall not engage in the practice of law, nor
shall any arbitrator hold any other office or position of
profit under the United States or this State or any municipal
corporation or political subdivision of this State.
Notwithstanding any other provision of this Act to the
contrary, an arbitrator who serves as an acting Commissioner in
accordance with the provisions of Section 13 of this Act shall
continue to serve in the capacity of Commissioner until a
decision is reached in every case heard by that arbitrator
while serving as an acting Commissioner.
Notwithstanding any other provision of this Section, the
term of all arbitrators serving on the effective date of this
amendatory Act of the 97th General Assembly, including any
arbitrators on administrative leave, shall terminate at the
close of business on July 1, 2011, but the incumbents shall

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continue to exercise all of their duties until they are
reappointed or their successors are appointed.
On and after the effective date of this amendatory Act of
the 97th General Assembly, arbitrators shall be appointed to
3-year terms as follows:
(1) All appointments shall be made by the Governor with
the advice and consent of the Senate.
(2) For their initial appointments, 12 arbitrators
shall be appointed to terms expiring July 1, 2012; 12
arbitrators shall be appointed to terms expiring July 1,
2013; and all additional arbitrators shall be appointed to
terms expiring July 1, 2014. Thereafter, all arbitrators
shall be appointed to 3-year terms.
Upon the expiration of a term, the Chairman shall evaluate
the performance of the arbitrator and may recommend to the
Governor that he or she be reappointed to a second or
subsequent term by the Governor with the advice and consent of
the Senate.
Each arbitrator appointed on or after the effective date of
this amendatory Act of the 97th General Assembly and who has
not previously served as an arbitrator for the Commission shall
be required to be authorized to practice law in this State by
the Supreme Court, and to maintain this authorization
throughout his or her term of employment.
The performance of all arbitrators shall be reviewed by the
Chairman on an annual basis. The Chairman shall allow input

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from the Commissioners in all such reviews.
The Commission shall assign no fewer than 3 arbitrators to
each hearing site. The Commission shall establish a procedure
to ensure that the arbitrators assigned to each hearing site
are assigned cases on a random basis. The Chairperson of the
Commission shall have discretion to assign and reassign
arbitrators to each hearing site as needed. No arbitrator shall
hear cases in any county, other than Cook County, for more than
2 years in each 3-year term.
The Secretary and each arbitrator shall receive a per annum
salary of $4,000 less than the per annum salary of members of
The Illinois Workers' Compensation Commission as provided in
Section 13 of this Act, payable in equal monthly installments.
The members of the Commission, Arbitrators and other
employees whose duties require them to travel, shall have
reimbursed to them their actual traveling expenses and
disbursements made or incurred by them in the discharge of
their official duties while away from their place of residence
in the performance of their duties.
The Commission shall provide itself with a seal for the
authentication of its orders, awards and proceedings upon which
shall be inscribed the name of the Commission and the words
"Illinois--Seal".
The Secretary or Assistant Secretary, under the direction
of the Commission, shall have charge and custody of the seal of
the Commission and also have charge and custody of all records,

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files, orders, proceedings, decisions, awards and other
documents on file with the Commission. He shall furnish
certified copies, under the seal of the Commission, of any such
records, files, orders, proceedings, decisions, awards and
other documents on file with the Commission as may be required.
Certified copies so furnished by the Secretary or Assistant
Secretary shall be received in evidence before the Commission
or any Arbitrator thereof, and in all courts, provided that the
original of such certified copy is otherwise competent and
admissible in evidence. The Secretary or Assistant Secretary
shall perform such other duties as may be prescribed from time
to time by the Commission.
(Source: P.A. 97-18, eff. 6-28-11; 97-719, eff. 6-29-12; 98-40,
eff. 6-28-13.)
(820 ILCS 305/14.2 new)
Sec. 14.2. Ombudsman Program.
(a) The Commission shall establish the Workers'
Compensation Ombudsman Program as an office within the Illinois
Workers' Compensation Commission no later than July 1, 2016.
The Ombudsman Program shall be composed of at least one
full-time ombudsman who shall develop a plan to provide
assistance to all regions of this State. One full-time
Ombudsman shall be designated as the Chief Ombudsman and the
Chief Ombudsman shall be an attorney licensed to practice law
in the State of Illinois and shall have demonstrated experience

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in Illinois workers' compensation law. The Ombudsman Program
shall be staffed with personnel who are trained in techniques
performed by ombudsmen and who are familiar with the provisions
of this Act and its rules, vocational rehabilitation
principles, the obligations of medical providers under this
Act, the provisions of the Medical Fee Schedule, an employer's
responsibility to maintain workers' compensation insurance,
the duties and obligations of self-insurers, and workers'
compensation fraud.
(b) The duties of the Ombudsman Program shall be as
follows:
(1) assist injured employees in understanding their
rights and obligations under this Act, including, but not
limited to, filing their own claims with the Commission and
obtaining medical records, job descriptions, and other
materials pertinent to filing a claim before the
Commission;
(2) assist employers seeking information regarding
their rights and obligations under this Act, including
their obligation to maintain workers' compensation
insurance;
(3) assist medical providers with their rights and
obligations under this Act;
(4) provide information to employers, employees, and
medical providers with questions about workers'
compensation fraud;

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(5) assist injured employees with referral to local,
State, and federal financial assistance, rehabilitation,
and work placement programs, as well as other social
services that the Ombudsman Program considers appropriate;
(6) respond to inquiries and complaints relative to the
workers' compensation program;
(7) serve as an information source for employees,
employers, medical, vocational, and rehabilitation
personnel, insurers, third-party administrators, and
self-insurers; and
(8) perform other duties as required by the Chairman.
(c) The Ombudsman Program may not appear or intervene, as a
party or otherwise, before the Commission on behalf of an
injured employee, employer, or medical provider. This Section
shall not be construed as requiring or allowing legal
representation for an injured employee by the Ombudsman Program
in any proceeding before the Commission.
(d) The Ombudsman Program shall prepare a report to the
Commission, which shall also be included in the Commission's
annual report required under Section 15 of this Act. The report
prepared by the Ombudsman Program shall include the following
information for the preceding fiscal year:
(1) the total number of persons and entities assisted
during the fiscal year;
(2) the number of injured employers assisted during the
fiscal year;

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(3) the number of employers, insurers, self-insureds,
and third-party administrators assisted during the fiscal
year;
(4) the total number of medical providers assisted
during the fiscal year;
(5) the number of referrals made to the Workers'
Compensation Fraud Unit;
(6) an analysis of the areas of workers' compensation
law requiring the most assistance for injured workers,
employers, and medical providers; and
(7) recommendations, if any, for legislation or rules
to be initiated by the Commission, based on the inquiries
received by the Ombudsman Program.
(820 ILCS 305/14.3 new)
Sec. 14.3. WEAR Commission.
(a) There is created the Workers' Compensation Edit,
Alignment, and Reform Commission, which shall be known as the
WEAR Commission. The purpose of the WEAR Commission is to
develop a proposed recodification of the Workers' Compensation
Act that meets the following goals:
(1) to make this Act more accessible to laypeople
seeking benefits under this Act and employers seeking
insurance coverage for their responsibilities under this
Act;
(2) to aid the Commission, attorneys, and judges in

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understanding and applying the provisions of this Act;
(3) to prevent disputes over interpretations of this
Act that can add additional costs to the function and
administration of the workers' compensation system;
(4) to reduce the size of each Section of this Act to
promote understanding, interpretation, and indexing of
this Act;
(5) to assist policymakers so that they can more easily
understand the implication of amendments to this Act that
may be proposed in the future;
(6) to replace outdated and obsolete language within
this Act;
(7) to limit the opportunity for lengthy and expensive
appeals due to confusion or contrary language within this
Act; and
(8) to meet the preceding objectives without changing
substantive law or disturbing established case law
precedent. Nothing in this Section 14.3 shall be construed
to allow or authorize the WEAR Commission to seek to or to
diminish, restrict, limit, expand, abrogate, alter, or
change in way the current interpretation of any substantive
or procedural provision of this Act by the Commission or
any Court.
(b) The members of the WEAR Commission shall be as follows:
(1) one Senator appointed by the President of the
Senate;

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(2) one Senator appointed by the Minority Leader of the
Senate;
(3) one Representative appointed by the Speaker of the
House of Representatives;
(4) one Representative appointed by the Minority
Leader of the House of Representatives;
(5) four attorneys representing petitioners, one each
appointed by the President of the Senate, Minority Leader
of the Senate, Speaker of the House of Representatives, and
Minority Leader of the House of Representatives; and
(6) four attorneys representing respondents, one each
appointed by the President of the Senate, Minority Leader
of the Senate, Speaker of the House of Representatives, and
Minority Leader of the House of Representatives.
The members of the WEAR Commission shall serve without
compensation. The Chairperson of the Illinois Workers'
Compensation Commission shall serve as the Chairperson of the
WEAR Commission.
(c) The Illinois Workers' Compensation Commission, the
Workers' Compensation Insurance Compliance Unit, and the
Legislative Reference Bureau shall provide administrative
support for the WEAR Commission.
(d) The WEAR Commission shall present a report to the
General Assembly no later than July 1, 2017. This report shall
include a draft of proposed legislation for the reorganization
of the Workers' Compensation Act that accomplishes the goals

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set forth by this Section.
(e) This Section is repealed on January 1, 2018.
(820 ILCS 305/14.4 new)
Sec. 14.4. System improvements.
(a) By January 1, 2017, the Commission shall procure and
implement a computer system to replace its current outdated and
obsolete mainframe computer system. The Commission shall use
the funds allocated for this purpose as set forth in the
settlement agreement for the case entitled Illinois State
Chamber of Commerce v. Filan.
(b) The system procured by the Commission shall have all of
the following capabilities:
(1) require the electronic filing of claims before the
Commission, including the Application for Adjustment of
Claim and all subsequent filings by a petitioner or
respondent; the electronic filing fields for the
Application of Adjustment of Claim shall include the
following:
(i) for cases involving the State of Illinois, a
data field for the specific agency, department,
constitutional officer, board, or commission;
(ii) a data field for the petitioner to indicate
that the claim involves a repetitive injury;
(iii) a data field for the petitioner to indicate
that the claim involved an injury incurred when the

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petitioner was traveling as part of his or her
employment; and
(iv) a data field for the petitioner to indicate
that he or she is pro se;
(2) allow for a respondent to indicate the insurance
carrier of the employer, or the third-party administrator
of the employer, if self-insured;
(3) allow for documents and exhibits to be uploaded
electronically;
(4) allow for the case history of each claim to be
viewed in a summary format arranged by the date of each
filing or hearing, which shall be available to the public;
(5) allow for the attorney of record for the
petitioner, if any, and the respondent to be clearly
indicated on any summary format, including the attorney who
actually tried or argued the case before an arbitrator or
Commissioner;
(6) allow for the decision of the arbitrator or the
Commission to be uploaded electronically;
(7) allow for the following data reports to be produced
from the electronic system:
(i) the total number of decisions by each
arbitrator within any time period;
(ii) the total number of awards by injury type,
including repetitive injuries or injuries suffered by
employees when traveling in the course of their

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employment or alleged to be suffered by employees when
traveling in the course of their employment;
(iii) the penalties assessed against employers,
searchable by each employer;
(iv) the total number of decisions by each panel of
Commissioners;
(v) the total number of claims filed by State
employees within any time period;
(vi) the total number of new claims filed in each
arbitration zone;
(vii) the total number of Settlement Contract Lump
Sum Petitions; and
(viii) the industry types of the employers against
whom claims are filed.
(7) allow for an electronic, searchable record of any
approved Settlement Contract Lump Sum Petitions, including
the amount of such Settlement Contract Lump Sum Petitions,
the type of injury, and the attorneys representing each
party, if any, for such Settlement Contract Lump Sum
Petitions;
(8) allow for the random assignment of cases by
arbitrator and to Commission panels, if appealed;
(9) allow for the electronic transmission of the record
of proceedings before the Commission to be transmitted to
the circuit court in the event of an appeal from the
Commission; and

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(10) ensure the confidentiality of all protected
information, including medical records.
(c) The Commission shall make all efforts to ensure that
parties practicing before the Commission, including injured
employees, are aware of the changes required by the procurement
of the computer system required by this Section.
(820 ILCS 305/25.5)
Sec. 25.5. Unlawful acts; penalties.
(a) It is unlawful for any person, company, corporation,
insurance carrier, healthcare provider, or other entity to:
(1) Intentionally present or cause to be presented any
false or fraudulent claim for the payment of any workers'
compensation benefit.
(2) Intentionally make or cause to be made any false or
fraudulent material statement or material representation
for the purpose of obtaining or denying any workers'
compensation benefit.
(3) Intentionally make or cause to be made any false or
fraudulent statements with regard to entitlement to
workers' compensation benefits with the intent to prevent
an injured worker from making a legitimate claim for any
workers' compensation benefits.
(4) Intentionally prepare or provide an invalid,
false, or counterfeit certificate of insurance as proof of
workers' compensation insurance.

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(5) Intentionally make or cause to be made any false or
fraudulent material statement or material representation
for the purpose of obtaining workers' compensation
insurance at less than the proper rate for that insurance.
(6) Intentionally make or cause to be made any false or
fraudulent material statement or material representation
on an initial or renewal self-insurance application or
accompanying financial statement for the purpose of
obtaining self-insurance status or reducing the amount of
security that may be required to be furnished pursuant to
Section 4 of this Act.
(7) Intentionally make or cause to be made any false or
fraudulent material statement to the Commission's
Department of Insurance's fraud and insurance
non-compliance unit in the course of an investigation of
fraud or insurance non-compliance.
(8) Intentionally assist, abet, solicit, or conspire
with any person, company, or other entity to commit any of
the acts in paragraph (1), (2), (3), (4), (5), (6), or (7)
of this subsection (a).
(9) Intentionally present a bill or statement for the
payment for medical services that were not provided.
For the purposes of paragraphs (2), (3), (5), (6), (7), and
(9), the term "statement" includes any writing, notice, proof
of injury, bill for services, hospital or doctor records and
reports, or X-ray and test results.

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(b) Sentences for violations of subsection (a) are as
follows:
(1) A violation in which the value of the property
obtained or attempted to be obtained is $300 or less is a
Class A misdemeanor.
(2) A violation in which the value of the property
obtained or attempted to be obtained is more than $300 but
not more than $10,000 is a Class 3 felony.
(3) A violation in which the value of the property
obtained or attempted to be obtained is more than $10,000
but not more than $100,000 is a Class 2 felony.
(4) A violation in which the value of the property
obtained or attempted to be obtained is more than $100,000
is a Class 1 felony.
(5) A person convicted under this Section shall be
ordered to pay monetary restitution to the insurance
company or self-insured entity or any other person for any
financial loss sustained as a result of a violation of this
Section, including any court costs and attorney fees. An
order of restitution also includes expenses incurred and
paid by the State of Illinois or an insurance company or
self-insured entity in connection with any medical
evaluation or treatment services.
For the purposes of this Section, where the exact value of
property obtained or attempted to be obtained is either not
alleged or is not specifically set by the terms of a policy of

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insurance, the value of the property shall be the fair market
replacement value of the property claimed to be lost, the
reasonable costs of reimbursing a vendor or other claimant for
services to be rendered, or both. Notwithstanding the
foregoing, an insurance company, self-insured entity, or any
other person suffering financial loss sustained as a result of
violation of this Section may seek restitution, including court
costs and attorney's fees in a civil action in a court of
competent jurisdiction.
(c) The Illinois Workers' Compensation Commission
Department of Insurance shall establish a fraud and insurance
non-compliance unit responsible for investigating incidences
of fraud and insurance non-compliance pursuant to this Section.
The size of the staff of the unit shall be subject to
appropriation by the General Assembly. It shall be the duty of
the fraud and insurance non-compliance unit to determine the
identity of insurance carriers, employers, employees, or other
persons or entities who have violated the fraud and insurance
non-compliance provisions of this Section. The fraud and
insurance non-compliance unit shall report violations of the
fraud and insurance non-compliance provisions of this Section
to the Special Prosecutions Bureau of the Criminal Division of
the Office of the Attorney General or to the State's Attorney
of the county in which the offense allegedly occurred, either
of whom has the authority to prosecute violations under this
Section.

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With respect to the subject of any investigation being
conducted, the fraud and insurance non-compliance unit shall
have the general power of subpoena of the Department of
Insurance, including the authority to issue a subpoena to a
medical provider, pursuant to Section 8-802 of the Code of
Civil Procedure.
(d) Any person may report allegations of insurance
non-compliance and fraud pursuant to this Section to the
Illinois Workers' Compensation Commission's Department of
Insurance's fraud and insurance non-compliance unit whose duty
it shall be to investigate the report. The unit shall notify
the Commission of reports of insurance non-compliance. Any
person reporting an allegation of insurance non-compliance or
fraud against either an employee or employer under this Section
must identify himself. Except as provided in this subsection
and in subsection (e), all reports shall remain confidential
except to refer an investigation to the Attorney General or
State's Attorney for prosecution or if the fraud and insurance
non-compliance unit's investigation reveals that the conduct
reported may be in violation of other laws or regulations of
the State of Illinois, the unit may report such conduct to the
appropriate governmental agency charged with administering
such laws and regulations. Any person who intentionally makes a
false report under this Section to the fraud and insurance
non-compliance unit is guilty of a Class A misdemeanor.
(e) In order for the fraud and insurance non-compliance

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unit to investigate a report of fraud related to an employee's
claim, (i) the employee must have filed with the Commission an
Application for Adjustment of Claim and the employee must have
either received or attempted to receive benefits under this Act
that are related to the reported fraud or (ii) the employee
must have made a written demand for the payment of benefits
that are related to the reported fraud. There shall be no
immunity, under this Act or otherwise, for any person who files
a false report or who files a report without good and just
cause. Confidentiality of medical information shall be
strictly maintained. Investigations that are not referred for
prosecution shall be destroyed upon the expiration of the
statute of limitations for the acts under investigation and
shall not be disclosed except that the person making the report
shall be notified that the investigation is being closed. It is
unlawful for any employer, insurance carrier, service
adjustment company, third party administrator, self-insured,
or similar entity to file or threaten to file a report of fraud
against an employee because of the exercise by the employee of
the rights and remedies granted to the employee by this Act.
(e-5) The fraud and insurance non-compliance unit shall
procure and implement a system utilizing advanced analytics
inclusive of predictive modeling, data mining, social network
analysis, and scoring algorithms for the detection and
prevention of fraud, waste, and abuse on or before January 1,
2012. The fraud and insurance non-compliance unit shall procure

SB0162 Engrossed - 32 - LRB099 03387 HEP 23395 b
this system using a request for proposals process governed by
the Illinois Procurement Code and rules adopted under that
Code. The fraud and insurance non-compliance unit shall provide
a report to the President of the Senate, Speaker of the House
of Representatives, Minority Leader of the House of
Representatives, Minority Leader of the Senate, Governor,
Chairman of the Commission, and Director of Insurance on or
before July 1, 2012 and annually thereafter detailing its
activities and providing recommendations regarding
opportunities for additional fraud waste and abuse detection
and prevention.
(f) Any person convicted of fraud related to workers'
compensation pursuant to this Section shall be subject to the
penalties prescribed in the Criminal Code of 2012 and shall be
ineligible to receive or retain any compensation, disability,
or medical benefits as defined in this Act if the compensation,
disability, or medical benefits were owed or received as a
result of fraud for which the recipient of the compensation,
disability, or medical benefit was convicted. This subsection
applies to accidental injuries or diseases that occur on or
after the effective date of this amendatory Act of the 94th
General Assembly.
(g) Civil liability. Any person convicted of fraud who
knowingly obtains, attempts to obtain, or causes to be obtained
any benefits under this Act by the making of a false claim or
who knowingly misrepresents any material fact shall be civilly

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liable to the payor of benefits or the insurer or the payor's
or insurer's subrogee or assignee in an amount equal to 3 times
the value of the benefits or insurance coverage wrongfully
obtained or twice the value of the benefits or insurance
coverage attempted to be obtained, plus reasonable attorney's
fees and expenses incurred by the payor or the payor's subrogee
or assignee who successfully brings a claim under this
subsection. This subsection applies to accidental injuries or
diseases that occur on or after the effective date of this
amendatory Act of the 94th General Assembly.
(h) The fraud and insurance non-compliance unit shall
submit a written report on an annual basis to the Chairman of
the Commission, the Workers' Compensation Advisory Board, the
General Assembly, the Governor, and the Attorney General by
January 1 and July 1 of each year. This report shall include,
at the minimum, the following information:
(1) The number of allegations of insurance
non-compliance and fraud reported to the fraud and
insurance non-compliance unit.
(2) The source of the reported allegations
(individual, employer, or other).
(3) The number of allegations investigated by the fraud
and insurance non-compliance unit.
(4) The number of criminal referrals made in accordance
with this Section and the entity to which the referral was
made.

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(5) All proceedings under this Section.