Bill Text: IL SB1309 | 2017-2018 | 100th General Assembly | Introduced

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Bill Title: Amends the Freedom of Information Act. Exempts from public inspection certain information collected by the Illinois Workers' Compensation Commission from self-insureds and papers, documents, reports, or evidence relevant to a workers' compensation fraud investigation conducted by the Department of Insurance. Amends the Criminal Code of 2012 regarding workers' compensation fraud penalties. Amends the Workers' Compensation Act. Makes changes concerning: accidental injuries that shall not be considered to be "arising out of and in the course of the employment"; the maximum compensation rate for a period of temporary total incapacity; wage differential benefits to professional athletes; limitations on the number of chiropractic, occupational therapy, or physical therapy visits an injured worker may receive for injuries; compensation awards for injuries to the shoulder and hip; the maximum allowable payment for certain service categories; the assignment and reassignment of arbitrators to hearing sites; the creation of an evidence based drug formulary; additional compensation awards where there has been a vexatious delay of authorization of medical treatment; annual reports on the state of self-insurance for workers' compensation in Illinois; and other matters. Effective immediately.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2019-01-09 - Session Sine Die [SB1309 Detail]

Download: Illinois-2017-SB1309-Introduced.html

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100TH GENERAL ASSEMBLY State of Illinois 2017 and 2018 SB1309 Introduced 2/9/2017, by Sen. Michael Connelly SYNOPSIS AS INTRODUCED:
See Index
Amends the Freedom of Information Act. Exempts from public inspection certain information collected by the Illinois Workers' Compensation Commission from self-insureds and papers, documents, reports, or evidence relevant to a workers' compensation fraud investigation conducted by the Department of Insurance. Amends the Criminal Code of 2012 regarding workers' compensation fraud penalties. Amends the Workers' Compensation Act. Makes changes concerning: accidental injuries that shall not be considered to be "arising out of and in the course of the employment"; the maximum compensation rate for a period of temporary total incapacity; wage differential benefits to professional athletes; limitations on the number of chiropractic, occupational therapy, or physical therapy visits an injured worker may receive for injuries; compensation awards for injuries to the shoulder and hip; the maximum allowable payment for certain service categories; the assignment and reassignment of arbitrators to hearing sites; the creation of an evidence based drug formulary; additional compensation awards where there has been a vexatious delay of authorization of medical treatment; annual reports on the state of self-insurance for workers' compensation in Illinois; and other matters. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning employment.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. The Freedom of Information Act is amended by
changing Section 7.5 as follows:
(5 ILCS 140/7.5)
Sec. 7.5. Statutory exemptions. To the extent provided for
by the statutes referenced below, the following shall be exempt
from inspection and copying:
(a) All information determined to be confidential
under Section 4002 of the Technology Advancement and
Development Act.
(b) Library circulation and order records identifying
library users with specific materials under the Library
Records Confidentiality Act.
(c) Applications, related documents, and medical
records received by the Experimental Organ Transplantation
Procedures Board and any and all documents or other records
prepared by the Experimental Organ Transplantation
Procedures Board or its staff relating to applications it
has received.
(d) Information and records held by the Department of
Public Health and its authorized representatives relating

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

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

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

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

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Act.
(aa) Information which is exempted from disclosure
under Section 2.37 of the Wildlife Code.
(bb) Information which is or was prohibited from
disclosure by the Juvenile Court Act of 1987.
(cc) Recordings made under the Law Enforcement
Officer-Worn Body Camera Act, except to the extent
authorized under that Act.
(dd) Information that is prohibited from being
disclosed under Section 45 of the Condominium and Common
Interest Community Ombudsperson Act.
(ee) (dd) Information that is exempted from disclosure
under Section 30.1 of the Pharmacy Practice Act.
(ff) Information the disclosure of which is restricted
and exempted under Sections 25.5 and 29.2 of the Workers'
Compensation Act.
(Source: P.A. 98-49, eff. 7-1-13; 98-63, eff. 7-9-13; 98-756,
eff. 7-16-14; 98-1039, eff. 8-25-14; 98-1045, eff. 8-25-14;
99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, eff. 1-1-16;
99-642, eff. 7-28-16; 99-776, eff. 8-12-16; 99-863, eff.
8-19-16; revised 9-1-16.)
Section 3. The Criminal Code of 2012 is amended by changing
Section 17-10.5 and by adding Section 17-10.4 as follows:
(720 ILCS 5/17-10.4 new)

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Sec. 17-10.4. Workers' compensation fraud.
(a) It is unlawful for any person, company, corporation,
insurance carrier, health care 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 benefit.
(4) Intentionally prepare or provide an invalid,
false, or counterfeit certificate of insurance as proof of
workers' compensation insurance.
(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 amount 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

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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 the Workers' Compensation Act.
(7) Intentionally make or cause to be made any false or
fraudulent material statement to the Department of
Insurance's fraud and insurance non-compliance unit in the
course of an investigation of fraud or insurance
non-compliance.
(8) Intentionally present a bill or statement for the
payment for medical services that were not provided.
(9) 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), (7), or
(8) of this subsection (a).
As used in paragraphs (2), (3), (5), (6), (7), and (8),
"statement" includes any writing, notice, proof of injury, bill
for services, hospital or doctor records and reports, or X-ray
and test results.
(b) Sentence.
(1) A violation of paragraph (a)(3) is a Class 4
felony.
(2) A violation of paragraph (a)(4) or (a)(7) is a
Class 3 felony.
(3) A violation of paragraph (a)(1), (a)(2), (a)(5),
(a)(6), or (a)(8) in which the value of the property

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obtained or attempted to be obtained is $500 or less is a
Class A misdemeanor.
(4) A violation of paragraph (a)(1), (a)(2), (a)(5),
(a)(6), or (a)(8) in which the value of the property
obtained or attempted to be obtained is more than $500 but
not more than $10,000 is a Class 3 felony.
(5) A violation of paragraph (a)(1), (a)(2), (a)(5),
(a)(6), or (a)(8) 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.
(6) A violation of paragraph (a)(1), (a)(2), (a)(5),
(a)(6), or (a)(8) in which the value of the property
obtained or attempted to be obtained is more than $100,000
is a Class 1 felony.
(7) A violation of paragraph (9) of subsection (a)
shall be punishable as the Class of offense for which the
person convicted assisted, abetted, solicited, or
conspired to commit, as set forth in paragraphs (1) through
(6) of this subsection.
(8) 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

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self-insured entity in connection with any medical
evaluation or treatment services.
For a violation of paragraph (a)(1) or (a)(2), the value of
the property obtained or attempted to be obtained includes
payments pursuant to the provisions of the Workers'
Compensation Act as well as the amount paid for medical
expenses. For a violation of paragraph (a)(5), the value of the
property obtained or attempted to be obtained is the difference
between the proper amount for the coverage sought or provided
and the actual amount billed for workers' compensation
insurance. For a violation of paragraph (a)(6), the value of
the property obtained or attempted to be obtained is the
difference between the proper amount of security required
pursuant to Section 4 of the Workers' Compensation Act and the
amount furnished pursuant the false or fraudulent statements or
representations. 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.
(720 ILCS 5/17-10.5)
Sec. 17-10.5. Insurance fraud.
(a) Insurance fraud.
(1) A person commits insurance fraud when he or she

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knowingly obtains, attempts to obtain, or causes to be
obtained, by deception, control over the property of an
insurance company or self-insured entity by the making of a
false claim or by causing a false claim to be made on any
policy of insurance issued by an insurance company or by
the making of a false claim or by causing a false claim to
be made to a self-insured entity, intending to deprive an
insurance company or self-insured entity permanently of
the use and benefit of that property.
(2) A person commits health care benefits fraud against
a provider, other than a governmental unit or agency, when
he or she knowingly obtains or attempts to obtain, by
deception, health care benefits and that obtaining or
attempt to obtain health care benefits does not involve
control over property of the provider.
(b) Aggravated insurance fraud.
(1) A person commits aggravated insurance fraud on a
private entity when he or she commits insurance fraud 3 or
more times within an 18-month period arising out of
separate incidents or transactions.
(2) A person commits being an organizer of an
aggravated insurance fraud on a private entity conspiracy
if aggravated insurance fraud on a private entity forms the
basis for a charge of conspiracy under Section 8-2 of this
Code and the person occupies a position of organizer,
supervisor, financer, or other position of management

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within the conspiracy.
(c) Conspiracy to commit insurance fraud. If aggravated
insurance fraud on a private entity forms the basis for charges
of conspiracy under Section 8-2 of this Code, the person or
persons with whom the accused is alleged to have agreed to
commit the 3 or more violations of this Section need not be the
same person or persons for each violation, as long as the
accused was a part of the common scheme or plan to engage in
each of the 3 or more alleged violations.
If aggravated insurance fraud on a private entity forms the
basis for a charge of conspiracy under Section 8-2 of this
Code, and the accused occupies a position of organizer,
supervisor, financer, or other position of management within
the conspiracy, the person or persons with whom the accused is
alleged to have agreed to commit the 3 or more violations of
this Section need not be the same person or persons for each
violation as long as the accused occupied a position of
organizer, supervisor, financer, or other position of
management in each of the 3 or more alleged violations.
(d) Sentence.
(1) A violation of paragraph (a)(1) in which the value
of the property obtained, attempted to be obtained, or
caused to be obtained is $500 $300 or less is a Class A
misdemeanor.
(2) A violation of paragraph (a)(1) in which the value
of the property obtained, attempted to be obtained, or

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caused to be obtained is more than $500 $300 but not more
than $10,000 is a Class 3 felony.
(3) A violation of paragraph (a)(1) in which the value
of the property obtained, attempted to be obtained, or
caused to be obtained is more than $10,000 but not more
than $100,000 is a Class 2 felony.
(4) A violation of paragraph (a)(1) in which the value
of the property obtained, attempted to be obtained, or
caused to be obtained is more than $100,000 is a Class 1
felony.
(5) A violation of paragraph (a)(2) is a Class A
misdemeanor.
(6) A violation of paragraph (b)(1) is a Class 1
felony, regardless of the value of the property obtained,
attempted to be obtained, or caused to be obtained.
(7) A violation of paragraph (b)(2) is a Class X
felony.
(8) A person convicted of insurance fraud, vendor
fraud, or a federal criminal violation associated with
defrauding the Medicaid program 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's fees. An order of
restitution shall include expenses incurred and paid by the
State of Illinois or an insurance company or self-insured

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entity in connection with any medical evaluation or
treatment services.
(9) Notwithstanding Section 8-5 of this Code, a person
may be convicted and sentenced both for the offense of
conspiracy to commit insurance fraud or the offense of
being an organizer of an aggravated insurance fraud
conspiracy and for any other offense that is the object of
the conspiracy.
(e) Civil damages for insurance fraud.
(1) A person who knowingly obtains, attempts to obtain,
or causes to be obtained, by deception, control over the
property of any insurance company by the making of a false
claim or by causing a false claim to be made on a policy of
insurance issued by an insurance company, or by the making
of a false claim or by causing a false claim to be made to a
self-insured entity, intending to deprive an insurance
company or self-insured entity permanently of the use and
benefit of that property, shall be civilly liable to the
insurance company or self-insured entity that paid the
claim or against whom the claim was made or to the subrogee
of that insurance company or self-insured entity in an
amount equal to either 3 times the value of the property
wrongfully obtained or, if no property was wrongfully
obtained, twice the value of the property attempted to be
obtained, whichever amount is greater, plus reasonable
attorney's fees.

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(2) An insurance company or self-insured entity that
brings an action against a person under paragraph (1) of
this subsection in bad faith shall be liable to that person
for twice the value of the property claimed, plus
reasonable attorney's fees. In determining whether an
insurance company or self-insured entity acted in bad
faith, the court shall relax the rules of evidence to allow
for the introduction of any facts or other information on
which the insurance company or self-insured entity may have
relied in bringing an action under paragraph (1) of this
subsection.
(f) Determination of property value. For the purposes of
this Section, if the exact value of the property attempted to
be obtained is either not alleged by the claimant or not
specifically set by the terms of a policy of 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.
(g) Actions by State licensing agencies.
(1) All State licensing agencies, the Illinois State
Police, and the Department of Financial and Professional
Regulation shall coordinate enforcement efforts relating
to acts of insurance fraud.
(2) If a person who is licensed or registered under the
laws of the State of Illinois to engage in a business or

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profession is convicted of or pleads guilty to engaging in
an act of insurance fraud, the Illinois State Police must
forward to each State agency by which the person is
licensed or registered a copy of the conviction or plea and
all supporting evidence.
(3) Any agency that receives information under this
Section shall, not later than 6 months after the date on
which it receives the information, publicly report the
final action taken against the convicted person, including
but not limited to the revocation or suspension of the
license or any other disciplinary action taken.
(h) Definitions. For the purposes of this Section,
"obtain", "obtains control", "deception", "property", and
"permanent deprivation" have the meanings ascribed to those
terms in Article 15 of this Code.
(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
Section 5. The Workers' Compensation Act is amended by
changing Sections 1, 4, 8, 8.1b, 8.2, 8.2a, 8.7, 14, 19, 25.5,
and 29.2 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,

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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
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

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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
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

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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
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

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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
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

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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
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

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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
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) To obtain compensation under this Act, an employee
bears the burden of showing, by a preponderance of the
evidence, that he or she has sustained accidental injuries
arising out of and in the course of the employment.
(1) An accidental injury shall not be considered to be
"arising out of and in the course of employment" if,

SB1309 - 23 - LRB100 08805 JLS 21036 b
without limitation, the accidental injury or the medical
condition for which compensation is sought:
(A) resulted from a hazard or risk that was not
incidental to the employment or did not occur at a time
and place and under circumstances reasonably required
by the employment;
(B) resulted from a personal or neutral risk
(including, in the case of an employee who is required
to travel for performance of job duties, a personal or
neutral risk associated with travel);
(C) occurred (i) while the claimant was traveling
away from the employer's premises and the travel was
not required for the performance of job duties or (ii)
during the claimant's commute to and from the
employer's premises; or
(D) occurred while the claimant (including a
claimant who is required to travel for performance of
job duties) (i) is on a paid or unpaid break and is not
performing any specific tasks for the employer during
the break or (ii) is on a personal detour or deviation,
regardless of whether or not the claimant is otherwise
traveling for employment purposes.
(2) A hazard or risk is not incidental to the
employment if it is a risk of everyday living commonly
faced by members of the general public, or is associated
with an activity of everyday life, regardless of whether

SB1309 - 24 - LRB100 08805 JLS 21036 b
the employee was performing an activity required by the
employment at the time of the injury or an activity
connected with what the employee has to do in fulfilling
his duties. A risk commonly faced by members of the general
public or associated with an activity of everyday life is a
neutral risk.
(3) In determining whether an employee is required to
travel for the performance of job duties, the following
factors shall 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 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;
and whether the employer received any benefit from the
employee traveling.
(4) Notwithstanding any provision of the Act to the
contrary, if an employee, who sustained an accidental
injury compensable under this Act which results in a
responsibility to pay compensation on the part of the
employer, subsequently sustains another injury due to his

SB1309 - 25 - LRB100 08805 JLS 21036 b
own intentional conduct or negligence that accelerates,
aggravates or worsens the effects or disability of the
first injury in any manner, regardless of whether or not he
has fully recovered from the effects of the first injury,
the employer's responsibility to pay compensation to the
employee or his or her dependents shall not be increased
due to the effects or disability resulting from the
subsequent injury.
(5) An injury, its occupational cause, and any
resulting manifestations or disability must be established
a reasonable degree of medical certainty, based on
objective relevant medical findings.
(Source: P.A. 97-18, eff. 6-28-11; 97-268, eff. 8-8-11; 97-813,
eff. 7-13-12.)
(820 ILCS 305/4) (from Ch. 48, par. 138.4)
Sec. 4. (a) Any employer, including but not limited to
general contractors and their subcontractors, who shall come
within the provisions of Section 3 of this Act, and any other
employer who shall elect to provide and pay the compensation
provided for in this Act shall:
(1) File with the Commission annually an application
for approval as a self-insurer which shall include a
current financial statement, and annually, thereafter, an
application for renewal of self-insurance, which shall
include a current financial statement. Said application

SB1309 - 26 - LRB100 08805 JLS 21036 b
and financial statement shall be signed and sworn to by the
president or vice president and secretary or assistant
secretary of the employer if it be a corporation, or by all
of the partners, if it be a copartnership, or by the owner
if it be neither a copartnership nor a corporation. All
initial applications and all applications for renewal of
self-insurance must be submitted at least 60 days prior to
the requested effective date of self-insurance. An
employer may elect to provide and pay compensation as
provided for in this Act as a member of a group workers'
compensation pool under Article V 3/4 of the Illinois
Insurance Code. If an employer becomes a member of a group
workers' compensation pool, the employer shall not be
relieved of any obligations imposed by this Act.
If the sworn application and financial statement of any
such employer does not satisfy the Commission of the
financial ability of the employer who has filed it, the
Commission shall require such employer to,
(2) Furnish security, indemnity or a bond guaranteeing
the payment by the employer of the compensation provided
for in this Act, provided that any such employer whose
application and financial statement shall not have
satisfied the commission of his or her financial ability
and who shall have secured his liability in part by excess
workers' compensation liability insurance shall be
required to furnish to the Commission security, indemnity

SB1309 - 27 - LRB100 08805 JLS 21036 b
or bond guaranteeing his or her payment up to the effective
limits of the excess coverage, or
(3) Insure his entire liability to pay such
compensation in some workers' compensation insurance
carrier authorized, licensed, or permitted to do such
insurance business in this State. Every policy of a
workers' compensation an insurance carrier, insuring the
payment of compensation under this Act shall cover all the
employees and the entire compensation liability of the
insured: Provided, however, that any employer may insure
his or her compensation liability with 2 or more workers'
compensation insurance carriers or may insure a part and
qualify under subsection 1, 2, or 4 for the remainder of
his or her liability to pay such compensation, subject to
the following two provisions:
Firstly, the entire compensation liability of the
employer to employees working at or from one location
shall be insured in one such workers' compensation
insurance carrier or shall be self-insured, and
Secondly, the employer shall submit evidence
satisfactorily to the Commission that his or her entire
liability for the compensation provided for in this Act
will be secured. Any provisions in any policy, or in
any endorsement attached thereto, attempting to limit
or modify in any way, the liability of the workers'
compensation insurance carriers issuing the same

SB1309 - 28 - LRB100 08805 JLS 21036 b
except as otherwise provided herein shall be wholly
void.
Nothing herein contained shall apply to policies of
excess liability carriage secured by employers who have
been approved by the Commission as self-insurers, or
(4) Make some other provision, satisfactory to the
Commission, for the securing of the payment of compensation
provided for in this Act, and
(5) Upon becoming subject to this Act and thereafter as
often as the Commission may in writing demand, file with
the Commission in form prescribed by it evidence of his or
her compliance with the provision of this Section.
(a-1) Regardless of its state of domicile or its principal
place of business, an employer shall make payments to its
workers' compensation insurance carrier or group
self-insurance fund, where applicable, based upon the premium
rates of the situs where the work or project is located in
Illinois if:
(A) the employer is engaged primarily in the building
and construction industry; and
(B) subdivision (a)(3) of this Section applies to the
employer or the employer is a member of a group
self-insurance plan as defined in subsection (1) of Section
4a.
The Illinois Workers' Compensation Commission shall impose
a penalty upon an employer for violation of this subsection

SB1309 - 29 - LRB100 08805 JLS 21036 b
(a-1) if:
(i) the employer is given an opportunity at a hearing
to present evidence of its compliance with this subsection
(a-1); and
(ii) after the hearing, the Commission finds that the
employer failed to make payments upon the premium rates of
the situs where the work or project is located in Illinois.
The penalty shall not exceed $1,000 for each day of work
for which the employer failed to make payments upon the premium
rates of the situs where the work or project is located in
Illinois, but the total penalty shall not exceed $50,000 for
each project or each contract under which the work was
performed.
Any penalty under this subsection (a-1) must be imposed not
later than one year after the expiration of the applicable
limitation period specified in subsection (d) of Section 6 of
this Act. Penalties imposed under this subsection (a-1) shall
be deposited into the Illinois Workers' Compensation
Commission Operations Fund, a special fund that is created in
the State treasury. Subject to appropriation, moneys in the
Fund shall be used solely for the operations of the Illinois
Workers' Compensation Commission and by the Department of
Insurance for the purposes authorized in subsection (c) of
Section 25.5 of this Act.
(a-2) Every Employee Leasing Company (ELC), as defined in
Section 15 of the Employee Leasing Company Act, shall at a

SB1309 - 30 - LRB100 08805 JLS 21036 b
minimum provide the following information to the Commission or
any entity designated by the Commission regarding each workers'
compensation insurance policy issued to the ELC:
(1) Any client company of the ELC listed as an
additional named insured.
(2) Any informational schedule attached to the master
policy that identifies any individual client company's
name, FEIN, and job location.
(3) Any certificate of workers' compensation insurance
coverage document issued to a client company specifying its
rights and obligations under the master policy that
establishes both the identity and status of the client, as
well as the dates of inception and termination of coverage,
if applicable.
(b) The sworn application and financial statement, or
security, indemnity or bond, or amount of insurance, or other
provisions, filed, furnished, carried, or made by the employer,
as the case may be, shall be subject to the approval of the
Commission.
Deposits under escrow agreements shall be cash, negotiable
United States government bonds or negotiable general
obligation bonds of the State of Illinois. Such cash or bonds
shall be deposited in escrow with any State or National Bank or
Trust Company having trust authority in the State of Illinois.
Upon the approval of the sworn application and financial
statement, security, indemnity or bond or amount of insurance,

SB1309 - 31 - LRB100 08805 JLS 21036 b
filed, furnished or carried, as the case may be, the Commission
shall send to the employer written notice of its approval
thereof. The certificate of compliance by the employer with the
provisions of subparagraphs (2) and (3) of paragraph (a) of
this Section shall be delivered by the workers' compensation
insurance carrier to the Illinois Workers' Compensation
Commission within five days after the effective date of the
policy so certified. The workers' compensation insurance so
certified shall cover all compensation liability occurring
during the time that the insurance is in effect and no further
certificate need be filed in case such insurance is renewed,
extended or otherwise continued by such carrier. The insurance
so certified shall not be cancelled or in the event that such
insurance is not renewed, extended or otherwise continued, such
insurance shall not be terminated until at least 10 days after
receipt by the Illinois Workers' Compensation Commission of
notice of the cancellation or termination of said insurance;
provided, however, that if the employer has secured insurance
from another workers' compensation insurance carrier, or has
otherwise secured the payment of compensation in accordance
with this Section, and such insurance or other security becomes
effective prior to the expiration of the 10 days, cancellation
or termination may, at the option of the insurance carrier
indicated in such notice, be effective as of the effective date
of such other insurance or security.
(c) Whenever the Commission shall find that any

SB1309 - 32 - LRB100 08805 JLS 21036 b
corporation, company, association, aggregation of individuals,
reciprocal or interinsurers exchange, or other insurer
effecting workers' compensation insurance in this State shall
be insolvent, financially unsound, or unable to fully meet all
payments and liabilities assumed or to be assumed for workers'
compensation insurance in this State, or shall practice a
policy of delay or unfairness toward employees in the
adjustment, settlement, or payment of benefits due such
employees, the Commission may after reasonable notice and
hearing order and direct that such corporation, company,
association, aggregation of individuals, reciprocal or
interinsurers exchange, or insurer, shall from and after a date
fixed in such order discontinue the writing of any such
workers' compensation insurance in this State. Subject to such
modification of the order as the Commission may later make on
review of the order, as herein provided, it shall thereupon be
unlawful for any such corporation, company, association,
aggregation of individuals, reciprocal or interinsurers
exchange, or insurer to effect any workers' compensation
insurance in this State. A copy of the order shall be served
upon the Director of Insurance by registered mail. Whenever the
Commission finds that any service or adjustment company used or
employed by a self-insured employer or by an insurance carrier
to process, adjust, investigate, compromise or otherwise
handle claims under this Act, has practiced or is practicing a
policy of delay or unfairness toward employees in the

SB1309 - 33 - LRB100 08805 JLS 21036 b
adjustment, settlement or payment of benefits due such
employees, the Commission may after reasonable notice and
hearing order and direct that such service or adjustment
company shall from and after a date fixed in such order be
prohibited from processing, adjusting, investigating,
compromising or otherwise handling claims under this Act.
Whenever the Commission finds that any self-insured
employer has practiced or is practicing delay or unfairness
toward employees in the adjustment, settlement or payment of
benefits due such employees, the Commission may, after
reasonable notice and hearing, order and direct that after a
date fixed in the order such self-insured employer shall be
disqualified to operate as a self-insurer and shall be required
to insure his entire liability to pay compensation in some
workers' compensation insurance carrier authorized, licensed
and permitted to do such insurance business in this State, as
provided in subparagraph 3 of paragraph (a) of this Section.
All orders made by the Commission under this Section shall
be subject to review by the courts, said review to be taken in
the same manner and within the same time as provided by Section
19 of this Act for review of awards and decisions of the
Commission, upon the party seeking the review filing with the
clerk of the court to which said review is taken a bond in an
amount to be fixed and approved by the court to which the
review is taken, conditioned upon the payment of all
compensation awarded against the person taking said review

SB1309 - 34 - LRB100 08805 JLS 21036 b
pending a decision thereof and further conditioned upon such
other obligations as the court may impose. Upon the review the
Circuit Court shall have power to review all questions of fact
as well as of law. The penalty hereinafter provided for in this
paragraph shall not attach and shall not begin to run until the
final determination of the order of the Commission.
(d) Whenever a panel of 3 Commissioners comprised of one
member of the employing class, one member of the employee
class, and one member not identified with either the employing
or employee class, with due process and after a hearing,
determines an employer has knowingly failed to provide coverage
as required by paragraph (a) of this Section, the failure shall
be deemed an immediate serious danger to public health, safety,
and welfare sufficient to justify service by the Commission of
a work-stop order on such employer, requiring the cessation of
all business operations of such employer at the place of
employment or job site. Any law enforcement agency in the State
shall, at the request of the Commission, render any assistance
necessary to carry out the provisions of this Section,
including, but not limited to, preventing any employee of such
employer from remaining at a place of employment or job site
after a work-stop order has taken effect. Any work-stop order
shall be lifted upon proof of workers' compensation insurance
as required by this Act. Any orders under this Section are
appealable under Section 19(f) to the Circuit Court.
Any individual employer, corporate officer or director of a

SB1309 - 35 - LRB100 08805 JLS 21036 b
corporate employer, partner of an employer partnership, or
member of an employer limited liability company who knowingly
fails to provide coverage as required by paragraph (a) of this
Section is guilty of a Class 4 felony. This provision shall not
apply to any corporate officer or director of any
publicly-owned corporation. Each day's violation constitutes a
separate offense. The State's Attorney of the county in which
the violation occurred, or the Attorney General, shall bring
such actions in the name of the People of the State of
Illinois, or may, in addition to other remedies provided in
this Section, bring an action for an injunction to restrain the
violation or to enjoin the operation of any such employer.
Any individual employer, corporate officer or director of a
corporate employer, partner of an employer partnership, or
member of an employer limited liability company who negligently
fails to provide coverage as required by paragraph (a) of this
Section is guilty of a Class A misdemeanor. This provision
shall not apply to any corporate officer or director of any
publicly-owned corporation. Each day's violation constitutes a
separate offense. The State's Attorney of the county in which
the violation occurred, or the Attorney General, shall bring
such actions in the name of the People of the State of
Illinois.
The criminal penalties in this subsection (d) shall not
apply where there exists a good faith dispute as to the
existence of an employment relationship. Evidence of good faith

SB1309 - 36 - LRB100 08805 JLS 21036 b
shall include, but not be limited to, compliance with the
definition of employee as used by the Internal Revenue Service.
Employers who are subject to and who knowingly fail to
comply with this Section shall not be entitled to the benefits
of this Act during the period of noncompliance, but shall be
liable in an action under any other applicable law of this
State. In the action, such employer shall not avail himself or
herself of the defenses of assumption of risk or negligence or
that the injury was due to a co-employee. In the action, proof
of the injury shall constitute prima facie evidence of
negligence on the part of such employer and the burden shall be
on such employer to show freedom of negligence resulting in the
injury. The employer shall not join any other defendant in any
such civil action. Nothing in this amendatory Act of the 94th
General Assembly shall affect the employee's rights under
subdivision (a)3 of Section 1 of this Act. Any employer or
carrier who makes payments under subdivision (a)3 of Section 1
of this Act shall have a right of reimbursement from the
proceeds of any recovery under this Section.
An employee of an uninsured employer, or the employee's
dependents in case death ensued, may, instead of proceeding
against the employer in a civil action in court, file an
application for adjustment of claim with the Commission in
accordance with the provisions of this Act and the Commission
shall hear and determine the application for adjustment of
claim in the manner in which other claims are heard and

SB1309 - 37 - LRB100 08805 JLS 21036 b
determined before the Commission.
All proceedings under this subsection (d) shall be reported
on an annual basis to the Workers' Compensation Advisory Board.
An investigator with the Illinois Workers' Compensation
Commission Insurance Compliance Division may issue a citation
to any employer that is not in compliance with its obligation
to have workers' compensation insurance under this Act. The
amount of the fine shall be based on the period of time the
employer was in non-compliance, but shall be no less than $500,
and shall not exceed $2,500. An employer that has been issued a
citation shall pay the fine to the Commission and provide to
the Commission proof that it obtained the required workers'
compensation insurance within 10 days after the citation was
issued. This Section does not affect any other obligations this
Act imposes on employers.
Upon a finding by the Commission, after reasonable notice
and hearing, of the knowing and wilful failure or refusal of an
employer to comply with any of the provisions of paragraph (a)
of this Section, the failure or refusal of an employer, service
or adjustment company, or an insurance carrier to comply with
any order of the Illinois Workers' Compensation Commission
pursuant to paragraph (c) of this Section disqualifying him or
her to operate as a self insurer and requiring him or her to
insure his or her liability, or the knowing and willful failure
of an employer to comply with a citation issued by an
investigator with the Illinois Workers' Compensation

SB1309 - 38 - LRB100 08805 JLS 21036 b
Commission Insurance Compliance Division, the Commission may
assess a civil penalty of up to $500 per day for each day of
such failure or refusal after the effective date of this
amendatory Act of 1989. The minimum penalty under this Section
shall be the sum of $10,000. Each day of such failure or
refusal shall constitute a separate offense. The Commission may
assess the civil penalty personally and individually against
the corporate officers and directors of a corporate employer,
the partners of an employer partnership, and the members of an
employer limited liability company, after a finding of a
knowing and willful refusal or failure of each such named
corporate officer, director, partner, or member to comply with
this Section. The liability for the assessed penalty shall be
against the named employer first, and if the named employer
fails or refuses to pay the penalty to the Commission within 30
days after the final order of the Commission, then the named
corporate officers, directors, partners, or members who have
been found to have knowingly and willfully refused or failed to
comply with this Section shall be liable for the unpaid penalty
or any unpaid portion of the penalty. Upon investigation by the
insurance non-compliance unit of the Commission, the Attorney
General shall have the authority to prosecute all proceedings
to enforce the civil and administrative provisions of this
Section before the Commission. The Commission shall promulgate
procedural rules for enforcing this Section.
Upon the failure or refusal of any employer, service or

SB1309 - 39 - LRB100 08805 JLS 21036 b
adjustment company or insurance carrier to comply with the
provisions of this Section and with the orders of the
Commission under this Section, or the order of the court on
review after final adjudication, the Commission may bring a
civil action to recover the amount of the penalty in Cook
County or in Sangamon County in which litigation the Commission
shall be represented by the Attorney General. The Commission
shall send notice of its finding of non-compliance and
assessment of the civil penalty to the Attorney General. It
shall be the duty of the Attorney General within 30 days after
receipt of the notice, to institute prosecutions and promptly
prosecute all reported violations of this Section.
Any individual employer, corporate officer or director of a
corporate employer, partner of an employer partnership, or
member of an employer limited liability company who, with the
intent to avoid payment of compensation under this Act to an
injured employee or the employee's dependents, knowingly
transfers, sells, encumbers, assigns, or in any manner disposes
of, conceals, secretes, or destroys any property belonging to
the employer, officer, director, partner, or member is guilty
of a Class 4 felony.
Penalties and fines collected pursuant to this paragraph
(d) shall be deposited upon receipt into a special fund which
shall be designated the Injured Workers' Benefit Fund, of which
the State Treasurer is ex-officio custodian, such special fund
to be held and disbursed in accordance with this paragraph (d)

SB1309 - 40 - LRB100 08805 JLS 21036 b
for the purposes hereinafter stated in this paragraph (d), upon
the final order of the Commission. The Injured Workers' Benefit
Fund shall be deposited the same as are State funds and any
interest accruing thereon shall be added thereto every 6
months. The Injured Workers' Benefit Fund is subject to audit
the same as State funds and accounts and is protected by the
general bond given by the State Treasurer. The Injured Workers'
Benefit Fund is considered always appropriated for the purposes
of disbursements as provided in this paragraph, and shall be
paid out and disbursed as herein provided and shall not at any
time be appropriated or diverted to any other use or purpose.
Moneys in the Injured Workers' Benefit Fund shall be used only
for payment of workers' compensation benefits for injured
employees when the employer has failed to provide coverage as
determined under this paragraph (d) and has failed to pay the
benefits due to the injured employee. The Commission shall have
the right to obtain reimbursement from the employer for
compensation obligations paid by the Injured Workers' Benefit
Fund. Any such amounts obtained shall be deposited by the
Commission into the Injured Workers' Benefit Fund. If an
injured employee or his or her personal representative receives
payment from the Injured Workers' Benefit Fund, the State of
Illinois has the same rights under paragraph (b) of Section 5
that the employer who failed to pay the benefits due to the
injured employee would have had if the employer had paid those
benefits, and any moneys recovered by the State as a result of

SB1309 - 41 - LRB100 08805 JLS 21036 b
the State's exercise of its rights under paragraph (b) of
Section 5 shall be deposited into the Injured Workers' Benefit
Fund. The custodian of the Injured Workers' Benefit Fund shall
be joined with the employer as a party respondent in the
application for adjustment of claim. After July 1, 2006, the
Commission shall make disbursements from the Fund once each
year to each eligible claimant. An eligible claimant is an
injured worker who has within the previous fiscal year obtained
a final award for benefits from the Commission against the
employer and the Injured Workers' Benefit Fund and has notified
the Commission within 90 days of receipt of such award. Within
a reasonable time after the end of each fiscal year, the
Commission shall make a disbursement to each eligible claimant.
At the time of disbursement, if there are insufficient moneys
in the Fund to pay all claims, each eligible claimant shall
receive a pro-rata share, as determined by the Commission, of
the available moneys in the Fund for that year. Payment from
the Injured Workers' Benefit Fund to an eligible claimant
pursuant to this provision shall discharge the obligations of
the Injured Workers' Benefit Fund regarding the award entered
by the Commission.
(e) This Act shall not affect or disturb the continuance of
any existing workers' compensation insurance, mutual aid,
benefit, or relief association or department, whether
maintained in whole or in part by the employer or whether
maintained by the employees, the payment of benefits of such

SB1309 - 42 - LRB100 08805 JLS 21036 b
association or department being guaranteed by the employer or
by some person, firm or corporation for him or her: Provided,
the employer contributes to such association or department an
amount not less than the full compensation herein provided,
exclusive of the cost of the maintenance of such association or
department and without any expense to the employee. This Act
shall not prevent the organization and maintaining under the
insurance laws of this State of any benefit or insurance
company for the purpose of insuring against the compensation
provided for in this Act, the expense of which is maintained by
the employer. This Act shall not prevent the organization or
maintaining under the insurance laws of this State of any
voluntary mutual aid, benefit or relief association among
employees for the payment of additional accident or sick
benefits.
(f) No existing workers' compensation insurance, mutual
aid, benefit or relief association or department shall, by
reason of anything herein contained, be authorized to
discontinue its operation without first discharging its
obligations to any and all persons carrying insurance in the
same or entitled to relief or benefits therein.
(g) Any contract, oral, written or implied, of employment
providing for relief benefit, or workers' compensation
insurance or any other device whereby the employee is required
to pay any premium or premiums for insurance against the
compensation provided for in this Act shall be null and void.

SB1309 - 43 - LRB100 08805 JLS 21036 b
Any employer withholding from the wages of any employee any
amount for the purpose of paying any such premium shall be
guilty of a Class B misdemeanor.
In the event the employer does not pay the compensation for
which he or she is liable, then a workers' compensation an
insurance company, association or insurer which may have
insured such employer against such liability shall become
primarily liable to pay to the employee, his or her personal
representative or beneficiary the compensation required by the
provisions of this Act to be paid by such employer. The
insurance carrier may be made a party to the proceedings in
which the employer is a party and an award may be entered
jointly against the employer and the insurance carrier.
(h) It shall be unlawful for any employer, insurance
company or service or adjustment company to interfere with,
restrain or coerce an employee in any manner whatsoever in the
exercise of the rights or remedies granted to him or her by
this Act or to discriminate, attempt to discriminate, or
threaten to discriminate against an employee in any way because
of his or her exercise of the rights or remedies granted to him
or her by this Act.
It shall be unlawful for any employer, individually or
through any insurance company or service or adjustment company,
to discharge or to threaten to discharge, or to refuse to
rehire or recall to active service in a suitable capacity an
employee because of the exercise of his or her rights or

SB1309 - 44 - LRB100 08805 JLS 21036 b
remedies granted to him or her by this Act.
(i) If an employer elects to obtain a life insurance policy
on his employees, he may also elect to apply such benefits in
satisfaction of all or a portion of the death benefits payable
under this Act, in which case, the employer's compensation
premium shall be reduced accordingly.
(j) Within 45 days of receipt of an initial application or
application to renew self-insurance privileges the
Self-Insurers Advisory Board shall review and submit for
approval by the Chairman of the Commission recommendations of
disposition of all initial applications to self-insure and all
applications to renew self-insurance privileges filed by
private self-insurers pursuant to the provisions of this
Section and Section 4a-9 of this Act. Each private self-insurer
shall submit with its initial and renewal applications the
application fee required by Section 4a-4 of this Act.
The Chairman of the Commission shall promptly act upon all
initial applications and applications for renewal in full
accordance with the recommendations of the Board or, should the
Chairman disagree with any recommendation of disposition of the
Self-Insurer's Advisory Board, he shall within 30 days of
receipt of such recommendation provide to the Board in writing
the reasons supporting his decision. The Chairman shall also
promptly notify the employer of his decision within 15 days of
receipt of the recommendation of the Board.
If an employer is denied a renewal of self-insurance

SB1309 - 45 - LRB100 08805 JLS 21036 b
privileges pursuant to application it shall retain said
privilege for 120 days after receipt of a notice of
cancellation of the privilege from the Chairman of the
Commission.
All orders made by the Chairman under this Section shall be
subject to review by the courts, such review to be taken in the
same manner and within the same time as provided by subsection
(f) of Section 19 of this Act for review of awards and
decisions of the Commission, upon the party seeking the review
filing with the clerk of the court to which such review is
taken a bond in an amount to be fixed and approved by the court
to which the review is taken, conditioned upon the payment of
all compensation awarded against the person taking such review
pending a decision thereof and further conditioned upon such
other obligations as the court may impose. Upon the review the
Circuit Court shall have power to review all questions of fact
as well as of law.
(Source: P.A. 97-18, eff. 6-28-11.)
(820 ILCS 305/8) (from Ch. 48, par. 138.8)
Sec. 8. The amount of compensation which shall be paid to
the employee for an accidental injury not resulting in death
is:
(a) The employer shall provide and pay the negotiated rate,
if applicable, or the lesser of the health care provider's
actual charges or according to a fee schedule, subject to

SB1309 - 46 - LRB100 08805 JLS 21036 b
Section 8.2, in effect at the time the service was rendered for
all the necessary first aid, medical and surgical services, and
all necessary medical, surgical and hospital services
thereafter incurred, limited, however, to that which is
reasonably required to cure or relieve from the effects of the
accidental injury, even if a health care provider sells,
transfers, or otherwise assigns an account receivable for
procedures, treatments, or services covered under this Act. If
the employer does not dispute payment of first aid, medical,
surgical, and hospital services, the employer shall make such
payment to the provider on behalf of the employee. The employer
shall also pay for treatment, instruction and training
necessary for the physical, mental and vocational
rehabilitation of the employee, including all maintenance
costs and expenses incidental thereto. If as a result of the
injury the employee is unable to be self-sufficient the
employer shall further pay for such maintenance or
institutional care as shall be required.
The employee may at any time elect to secure his own
physician, surgeon and hospital services at the employer's
expense, or,
Upon agreement between the employer and the employees, or
the employees' exclusive representative, and subject to the
approval of the Illinois Workers' Compensation Commission, the
employer shall maintain a list of physicians, to be known as a
Panel of Physicians, who are accessible to the employees. The

SB1309 - 47 - LRB100 08805 JLS 21036 b
employer shall post this list in a place or places easily
accessible to his employees. The employee shall have the right
to make an alternative choice of physician from such Panel if
he is not satisfied with the physician first selected. If, due
to the nature of the injury or its occurrence away from the
employer's place of business, the employee is unable to make a
selection from the Panel, the selection process from the Panel
shall not apply. The physician selected from the Panel may
arrange for any consultation, referral or other specialized
medical services outside the Panel at the employer's expense.
Provided that, in the event the Commission shall find that a
doctor selected by the employee is rendering improper or
inadequate care, the Commission may order the employee to
select another doctor certified or qualified in the medical
field for which treatment is required. If the employee refuses
to make such change the Commission may relieve the employer of
his obligation to pay the doctor's charges from the date of
refusal to the date of compliance.
Any vocational rehabilitation counselors who provide
service under this Act shall have appropriate certifications
which designate the counselor as qualified to render opinions
relating to vocational rehabilitation. Vocational
rehabilitation may include, but is not limited to, counseling
for job searches, supervising a job search program, and
vocational retraining including education at an accredited
learning institution. The employee or employer may petition to

SB1309 - 48 - LRB100 08805 JLS 21036 b
the Commission to decide disputes relating to vocational
rehabilitation and the Commission shall resolve any such
dispute, including payment of the vocational rehabilitation
program by the employer.
The maintenance benefit shall not be less than the
temporary total disability rate determined for the employee. In
addition, maintenance shall include costs and expenses
incidental to the vocational rehabilitation program.
When the employee is working light duty on a part-time
basis or full-time basis and earns less than he or she would be
earning if employed in the full capacity of the job or jobs,
then the employee shall be entitled to temporary partial
disability benefits. Temporary partial disability benefits
shall be equal to two-thirds of the difference between the
average amount that the employee would be able to earn in the
full performance of his or her duties in the occupation in
which he or she was engaged at the time of accident and the
gross amount which he or she is earning in the modified job
provided to the employee by the employer or in any other job
that the employee is working.
Every hospital, physician, surgeon or other person
rendering treatment or services in accordance with the
provisions of this Section shall upon written request furnish
full and complete reports thereof to, and permit their records
to be copied by, the employer, the employee or his dependents,
as the case may be, or any other party to any proceeding for

SB1309 - 49 - LRB100 08805 JLS 21036 b
compensation before the Commission, or their attorneys.
Notwithstanding the foregoing, the employer's liability to
pay for such medical services selected by the employee shall be
limited to:
(1) all first aid and emergency treatment; plus
(2) all medical, surgical and hospital services
provided by the physician, surgeon or hospital initially
chosen by the employee or by any other physician,
consultant, expert, institution or other provider of
services recommended by said initial service provider or
any subsequent provider of medical services in the chain of
referrals from said initial service provider; plus
(3) all medical, surgical and hospital services
provided by any second physician, surgeon or hospital
subsequently chosen by the employee or by any other
physician, consultant, expert, institution or other
provider of services recommended by said second service
provider or any subsequent provider of medical services in
the chain of referrals from said second service provider.
Thereafter the employer shall select and pay for all
necessary medical, surgical and hospital treatment and the
employee may not select a provider of medical services at
the employer's expense unless the employer agrees to such
selection. At any time the employee may obtain any medical
treatment he desires at his own expense. This paragraph
shall not affect the duty to pay for rehabilitation

SB1309 - 50 - LRB100 08805 JLS 21036 b
referred to above.
(4) The following shall apply for injuries occurring on
or after June 28, 2011 (the effective date of Public Act
97-18) and only when an employer has an approved preferred
provider program pursuant to Section 8.1a on the date the
employee sustained his or her accidental injuries:
(A) The employer shall, in writing, on a form
promulgated by the Commission, inform the employee of
the preferred provider program;
(B) Subsequent to the report of an injury by an
employee, the employee may choose in writing at any
time to decline the preferred provider program, in
which case that would constitute one of the two choices
of medical providers to which the employee is entitled
under subsection (a)(2) or (a)(3); and
(C) Prior to the report of an injury by an
employee, when an employee chooses non-emergency
treatment from a provider not within the preferred
provider program, that would constitute the employee's
one choice of medical providers to which the employee
is entitled under subsection (a)(2) or (a)(3).
When an employer and employee so agree in writing, nothing
in this Act prevents an employee whose injury or disability has
been established under this Act, from relying in good faith, on
treatment by prayer or spiritual means alone, in accordance
with the tenets and practice of a recognized church or

SB1309 - 51 - LRB100 08805 JLS 21036 b
religious denomination, by a duly accredited practitioner
thereof, and having nursing services appropriate therewith,
without suffering loss or diminution of the compensation
benefits under this Act. However, the employee shall submit to
all physical examinations required by this Act. The cost of
such treatment and nursing care shall be paid by the employee
unless the employer agrees to make such payment.
Where the accidental injury results in the amputation of an
arm, hand, leg or foot, or the enucleation of an eye, or the
loss of any of the natural teeth, the employer shall furnish an
artificial of any such members lost or damaged in accidental
injury arising out of and in the course of employment, and
shall also furnish the necessary braces in all proper and
necessary cases. In cases of the loss of a member or members by
amputation, the employer shall, whenever necessary, maintain
in good repair, refit or replace the artificial limbs during
the lifetime of the employee. Where the accidental injury
accompanied by physical injury results in damage to a denture,
eye glasses or contact eye lenses, or where the accidental
injury results in damage to an artificial member, the employer
shall replace or repair such denture, glasses, lenses, or
artificial member.
The furnishing by the employer of any such services or
appliances is not an admission of liability on the part of the
employer to pay compensation.
The furnishing of any such services or appliances or the

SB1309 - 52 - LRB100 08805 JLS 21036 b
servicing thereof by the employer is not the payment of
compensation.
(b) If the period of temporary total incapacity for work
lasts more than 7 3 working days, weekly compensation as
hereinafter provided shall be paid beginning on the 8th 4th day
of such temporary total incapacity and continuing as long as
the total temporary incapacity lasts. In cases where the
temporary total incapacity for work continues for a period of
14 days or more from the day of the accident compensation shall
commence on the day after the accident.
1. The compensation rate for temporary total
incapacity under this paragraph (b) of this Section shall
be equal to 66 2/3% of the employee's average weekly wage
computed in accordance with Section 10, provided that it
shall be not less than 66 2/3% of the sum of the Federal
minimum wage under the Fair Labor Standards Act, or the
Illinois minimum wage under the Minimum Wage Law, whichever
is more, multiplied by 40 hours. This percentage rate shall
be increased by 10% for each spouse and child, not to
exceed 100% of the total minimum wage calculation, nor
exceed the employee's average weekly wage computed in
accordance with the provisions of Section 10, whichever is
less.
2. The compensation rate in all cases other than for
temporary total disability under this paragraph (b), and
other than for serious and permanent disfigurement under

SB1309 - 53 - LRB100 08805 JLS 21036 b
paragraph (c) and other than for permanent partial
disability under subparagraph (2) of paragraph (d) or under
paragraph (e), of this Section shall be equal to 66 2/3% of
the employee's average weekly wage computed in accordance
with the provisions of Section 10, provided that it shall
be not less than 66 2/3% of the sum of the Federal minimum
wage under the Fair Labor Standards Act, or the Illinois
minimum wage under the Minimum Wage Law, whichever is more,
multiplied by 40 hours. This percentage rate shall be
increased by 10% for each spouse and child, not to exceed
100% of the total minimum wage calculation, nor exceed the
employee's average weekly wage computed in accordance with
the provisions of Section 10, whichever is less.
2.1. The compensation rate in all cases of serious and
permanent disfigurement under paragraph (c) and of
permanent partial disability under subparagraph (2) of
paragraph (d) or under paragraph (e) of this Section shall
be equal to 60% of the employee's average weekly wage
computed in accordance with the provisions of Section 10,
provided that it shall be not less than 66 2/3% of the sum
of the Federal minimum wage under the Fair Labor Standards
Act, or the Illinois minimum wage under the Minimum Wage
Law, whichever is more, multiplied by 40 hours. This
percentage rate shall be increased by 10% for each spouse
and child, not to exceed 100% of the total minimum wage
calculation, nor exceed the employee's average weekly wage

SB1309 - 54 - LRB100 08805 JLS 21036 b
computed in accordance with the provisions of Section 10,
whichever is less.
3. As used in this Section the term "child" means a
child of the employee including any child legally adopted
before the accident or whom at the time of the accident the
employee was under legal obligation to support or to whom
the employee stood in loco parentis, and who at the time of
the accident was under 18 years of age and not emancipated.
The term "children" means the plural of "child".
4. All weekly compensation rates provided under
subparagraphs 1, 2 and 2.1 of this paragraph (b) of this
Section shall be subject to the following limitations:
The maximum weekly compensation rate from July 1, 1975,
except as hereinafter provided, shall be 100% of the
State's average weekly wage in covered industries under the
Unemployment Insurance Act, that being the wage that most
closely approximates the State's average weekly wage.
The maximum weekly compensation rate, for the period
July 1, 1984, through June 30, 1987, except as hereinafter
provided, shall be $293.61. Effective July 1, 1987 and on
July 1 of each year thereafter the maximum weekly
compensation rate, except as hereinafter provided, shall
be determined as follows: if during the preceding 12 month
period there shall have been an increase in the State's
average weekly wage in covered industries under the
Unemployment Insurance Act, the weekly compensation rate

SB1309 - 55 - LRB100 08805 JLS 21036 b
shall be proportionately increased by the same percentage
as the percentage of increase in the State's average weekly
wage in covered industries under the Unemployment
Insurance Act during such period.
The maximum weekly compensation rate, for the period
January 1, 1981 through December 31, 1983, except as
hereinafter provided, shall be 100% of the State's average
weekly wage in covered industries under the Unemployment
Insurance Act in effect on January 1, 1981. Effective
January 1, 1984 and on January 1, of each year thereafter
the maximum weekly compensation rate, except as
hereinafter provided, shall be determined as follows: if
during the preceding 12 month period there shall have been
an increase in the State's average weekly wage in covered
industries under the Unemployment Insurance Act, the
weekly compensation rate shall be proportionately
increased by the same percentage as the percentage of
increase in the State's average weekly wage in covered
industries under the Unemployment Insurance Act during
such period.
The maximum compensation rate for the period of June 1,
2017 through May 31, 2022, except as hereinafter provided,
shall be $775.18. Effective May 31, 2022 and on May 31 of
each year thereafter the maximum weekly compensation rate,
except as hereinafter provided, shall be determined as
follows: if during the preceding 12 month period there

SB1309 - 56 - LRB100 08805 JLS 21036 b
shall have been an increase in the State's average weekly
wage in covered industries under the Unemployment
Insurance Act, the weekly compensation rate shall
proportionately increase by the same percentage as the
percentage increase in the State's average weekly wage in
covered industries under the Unemployment Insurance Act
during such period.
From July 1, 1977 and thereafter such maximum weekly
compensation rate in death cases under Section 7, and
permanent total disability cases under paragraph (f) or
subparagraph 18 of paragraph (3) of this Section and for
temporary total disability under paragraph (b) of this
Section and for amputation of a member or enucleation of an
eye under paragraph (e) of this Section shall be increased
to 133-1/3% of the State's average weekly wage in covered
industries under the Unemployment Insurance Act.
For injuries occurring on or after February 1, 2006,
the maximum weekly benefit under paragraph (d)1 of this
Section shall be 100% of the State's average weekly wage in
covered industries under the Unemployment Insurance Act.
4.1. Any provision herein to the contrary
notwithstanding, the weekly compensation rate for
compensation payments under subparagraph 18 of paragraph
(e) of this Section and under paragraph (f) of this Section
and under paragraph (a) of Section 7 and for amputation of
a member or enucleation of an eye under paragraph (e) of

SB1309 - 57 - LRB100 08805 JLS 21036 b
this Section, shall in no event be less than 50% of the
State's average weekly wage in covered industries under the
Unemployment Insurance Act.
4.2. Any provision to the contrary notwithstanding,
the total compensation payable under Section 7 shall not
exceed the greater of $500,000 or 25 years.
5. For the purpose of this Section this State's average
weekly wage in covered industries under the Unemployment
Insurance Act on July 1, 1975 is hereby fixed at $228.16
per week and the computation of compensation rates shall be
based on the aforesaid average weekly wage until modified
as hereinafter provided.
6. The Department of Employment Security of the State
shall on or before the first day of December, 1977, and on
or before the first day of June, 1978, and on the first day
of each December and June of each year thereafter, publish
the State's average weekly wage in covered industries under
the Unemployment Insurance Act and the Illinois Workers'
Compensation Commission shall on the 15th day of January,
1978 and on the 15th day of July, 1978 and on the 15th day
of each January and July of each year thereafter, post and
publish the State's average weekly wage in covered
industries under the Unemployment Insurance Act as last
determined and published by the Department of Employment
Security. The amount when so posted and published shall be
conclusive and shall be applicable as the basis of

SB1309 - 58 - LRB100 08805 JLS 21036 b
computation of compensation rates until the next posting
and publication as aforesaid.
7. The payment of compensation by an employer or his
insurance carrier to an injured employee shall not
constitute an admission of the employer's liability to pay
compensation.
(c) For any serious and permanent disfigurement to the
hand, head, face, neck, arm, leg below the knee or the chest
above the axillary line, the employee is entitled to
compensation for such disfigurement, the amount determined by
agreement at any time or by arbitration under this Act, at a
hearing not less than 6 months after the date of the accidental
injury, which amount shall not exceed 150 weeks (if the
accidental injury occurs on or after the effective date of this
amendatory Act of the 94th General Assembly but before February
1, 2006) or 162 weeks (if the accidental injury occurs on or
after February 1, 2006) at the applicable rate provided in
subparagraph 2.1 of paragraph (b) of this Section.
No compensation is payable under this paragraph where
compensation is payable under paragraphs (d), (e) or (f) of
this Section.
A duly appointed member of a fire department in a city, the
population of which exceeds 500,000 according to the last
federal or State census, is eligible for compensation under
this paragraph only where such serious and permanent
disfigurement results from burns.

SB1309 - 59 - LRB100 08805 JLS 21036 b
(d) 1. If, after the accidental injury has been sustained,
the employee as a result thereof becomes partially
incapacitated from pursuing his usual and customary line of
employment, he shall, except in cases compensated under the
specific schedule set forth in paragraph (e) of this Section,
receive compensation for the duration of his disability,
subject to the limitations as to maximum amounts fixed in
paragraph (b) of this Section, equal to 66-2/3% of the
difference between the average amount which he would be able to
earn in the full performance of his duties in the occupation in
which he was engaged at the time of the accident and the
average amount which he is earning or is able to earn in some
suitable employment or business after the accident. For
accidental injuries that occur on or after September 1, 2011,
an award for wage differential under this subsection shall be
effective only until the employee reaches the age of 67 or 5
years from the date the award becomes final, whichever is
later.
For accidental injuries involving professional athletes
that occur on or after the effective date of this amendatory
Act of the 100th General Assembly, an award for wage
differential under this subsection shall be effective for the
expected remaining duration of the employee's professional
sports athletic career. As used in this paragraph (d)1,
"professional athlete" means an individual whose employer is a
professional athletic team that is based in Illinois and who

SB1309 - 60 - LRB100 08805 JLS 21036 b
derives the majority of his or her income from playing
athletics for such team. The expected remaining duration of an
employee's professional sports athletic career shall continue
until the employee reaches the age of 35 or for a period of 5
years from the date of the injury, whichever is later, unless
the employer or employee is able to successfully prove, by a
preponderance of the evidence, that the expected remaining
duration of such employee's professional sports athletic
career has a shorter or longer duration.
2. If, as a result of the accident, the employee sustains
serious and permanent injuries not covered by paragraphs (c)
and (e) of this Section or having sustained injuries covered by
the aforesaid paragraphs (c) and (e), he shall have sustained
in addition thereto other injuries which injuries do not
incapacitate him from pursuing the duties of his employment but
which would disable him from pursuing other suitable
occupations, or which have otherwise resulted in physical
impairment; or if such injuries partially incapacitate him from
pursuing the duties of his usual and customary line of
employment but do not result in an impairment of earning
capacity, or having resulted in an impairment of earning
capacity, the employee elects to waive his right to recover
under the foregoing subparagraph 1 of paragraph (d) of this
Section then in any of the foregoing events, he shall receive
in addition to compensation for temporary total disability
under paragraph (b) of this Section, compensation at the rate

SB1309 - 61 - LRB100 08805 JLS 21036 b
provided in subparagraph 2.1 of paragraph (b) of this Section
for that percentage of 500 weeks that the partial disability
resulting from the injuries covered by this paragraph bears to
total disability. If the employee shall have sustained a
fracture of one or more vertebra or fracture of the skull, the
amount of compensation allowed under this Section shall be not
less than 6 weeks for a fractured skull and 6 weeks for each
fractured vertebra, and in the event the employee shall have
sustained a fracture of any of the following facial bones:
nasal, lachrymal, vomer, zygoma, maxilla, palatine or
mandible, the amount of compensation allowed under this Section
shall be not less than 2 weeks for each such fractured bone,
and for a fracture of each transverse process not less than 3
weeks. In the event such injuries shall result in the loss of a
kidney, spleen or lung, the amount of compensation allowed
under this Section shall be not less than 10 weeks for each
such organ. Compensation awarded under this subparagraph 2
shall not take into consideration injuries covered under
paragraphs (c) and (e) of this Section and the compensation
provided in this paragraph shall not affect the employee's
right to compensation payable under paragraphs (b), (c) and (e)
of this Section for the disabilities therein covered.
(e) For accidental injuries in the following schedule, the
employee shall receive compensation for the period of temporary
total incapacity for work resulting from such accidental
injury, under subparagraph 1 of paragraph (b) of this Section,

SB1309 - 62 - LRB100 08805 JLS 21036 b
and shall receive in addition thereto compensation for a
further period for the specific loss herein mentioned, but
shall not receive any compensation under any other provisions
of this Act. The following listed amounts apply to either the
loss of or the permanent and complete loss of use of the member
specified, such compensation for the length of time as follows:
1. Thumb-
70 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
76 weeks if the accidental injury occurs on or
after February 1, 2006.
2. First, or index finger-
40 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
43 weeks if the accidental injury occurs on or
after February 1, 2006.
3. Second, or middle finger-
35 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
38 weeks if the accidental injury occurs on or
after February 1, 2006.
4. Third, or ring finger-
25 weeks if the accidental injury occurs on or

SB1309 - 63 - LRB100 08805 JLS 21036 b
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
27 weeks if the accidental injury occurs on or
after February 1, 2006.
5. Fourth, or little finger-
20 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
22 weeks if the accidental injury occurs on or
after February 1, 2006.
6. Great toe-
35 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
38 weeks if the accidental injury occurs on or
after February 1, 2006.
7. Each toe other than great toe-
12 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
13 weeks if the accidental injury occurs on or
after February 1, 2006.
8. The loss of the first or distal phalanx of the thumb
or of any finger or toe shall be considered to be equal to
the loss of one-half of such thumb, finger or toe and the
compensation payable shall be one-half of the amount above

SB1309 - 64 - LRB100 08805 JLS 21036 b
specified. The loss of more than one phalanx shall be
considered as the loss of the entire thumb, finger or toe.
In no case shall the amount received for more than one
finger exceed the amount provided in this schedule for the
loss of a hand.
9. Hand-
190 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
205 weeks if the accidental injury occurs on or
after February 1, 2006.
190 weeks if the accidental injury occurs on or
after June 28, 2011 (the effective date of Public Act
97-18) and if the accidental injury involves carpal
tunnel syndrome due to repetitive or cumulative
trauma, in which case the permanent partial disability
shall not exceed 15% loss of use of the hand, except
for cause shown by clear and convincing evidence and in
which case the award shall not exceed 30% loss of use
of the hand.
The loss of 2 or more digits, or one or more phalanges
of 2 or more digits, of a hand may be compensated on the
basis of partial loss of use of a hand, provided, further,
that the loss of 4 digits, or the loss of use of 4 digits,
in the same hand shall constitute the complete loss of a
hand.

SB1309 - 65 - LRB100 08805 JLS 21036 b
10. Arm-
235 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
253 weeks if the accidental injury occurs on or
after February 1, 2006.
Where an accidental injury results in the amputation of
an arm below the elbow, such injury shall be compensated as
a loss of an arm. Where an accidental injury results in the
amputation of an arm above the elbow, compensation for an
additional 15 weeks (if the accidental injury occurs on or
after the effective date of this amendatory Act of the 94th
General Assembly but before February 1, 2006) or an
additional 17 weeks (if the accidental injury occurs on or
after February 1, 2006) shall be paid, except where the
accidental injury results in the amputation of an arm at
the shoulder joint, or so close to shoulder joint that an
artificial arm cannot be used, or results in the
disarticulation of an arm at the shoulder joint, in which
case compensation for an additional 65 weeks (if the
accidental injury occurs on or after the effective date of
this amendatory Act of the 94th General Assembly but before
February 1, 2006) or an additional 70 weeks (if the
accidental injury occurs on or after February 1, 2006)
shall be paid.
For purposes of awards under this subdivision (e),

SB1309 - 66 - LRB100 08805 JLS 21036 b
injuries to the shoulder shall be considered injuries to
part of the arm. The foregoing change made by this
amendatory Act of the 100th General Assembly to this
subdivision (e)10 of this Section 8 is declarative of
existing law and is not a new enactment.
11. Foot-
155 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
167 weeks if the accidental injury occurs on or
after February 1, 2006.
12. Leg-
200 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
215 weeks if the accidental injury occurs on or
after February 1, 2006.
Where an accidental injury results in the amputation of
a leg below the knee, such injury shall be compensated as
loss of a leg. Where an accidental injury results in the
amputation of a leg above the knee, compensation for an
additional 25 weeks (if the accidental injury occurs on or
after the effective date of this amendatory Act of the 94th
General Assembly but before February 1, 2006) or an
additional 27 weeks (if the accidental injury occurs on or
after February 1, 2006) shall be paid, except where the

SB1309 - 67 - LRB100 08805 JLS 21036 b
accidental injury results in the amputation of a leg at the
hip joint, or so close to the hip joint that an artificial
leg cannot be used, or results in the disarticulation of a
leg at the hip joint, in which case compensation for an
additional 75 weeks (if the accidental injury occurs on or
after the effective date of this amendatory Act of the 94th
General Assembly but before February 1, 2006) or an
additional 81 weeks (if the accidental injury occurs on or
after February 1, 2006) shall be paid.
For purposes of awards under this subdivision (e),
injuries to the hip shall be considered injuries to part of
the leg. The foregoing change made by this amendatory Act
of the 100th General Assembly to this subdivision (e)12 of
this Section 8 is declarative of existing law and is not a
new enactment.
13. Eye-
150 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
162 weeks if the accidental injury occurs on or
after February 1, 2006.
Where an accidental injury results in the enucleation
of an eye, compensation for an additional 10 weeks (if the
accidental injury occurs on or after the effective date of
this amendatory Act of the 94th General Assembly but before
February 1, 2006) or an additional 11 weeks (if the

SB1309 - 68 - LRB100 08805 JLS 21036 b
accidental injury occurs on or after February 1, 2006)
shall be paid.
14. Loss of hearing of one ear-
50 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
54 weeks if the accidental injury occurs on or
after February 1, 2006.
Total and permanent loss of hearing of both ears-
200 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
215 weeks if the accidental injury occurs on or
after February 1, 2006.
15. Testicle-
50 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
54 weeks if the accidental injury occurs on or
after February 1, 2006.
Both testicles-
150 weeks if the accidental injury occurs on or
after the effective date of this amendatory Act of the
94th General Assembly but before February 1, 2006.
162 weeks if the accidental injury occurs on or
after February 1, 2006.

SB1309 - 69 - LRB100 08805 JLS 21036 b
16. For the permanent partial loss of use of a member
or sight of an eye, or hearing of an ear, compensation
during that proportion of the number of weeks in the
foregoing schedule provided for the loss of such member or
sight of an eye, or hearing of an ear, which the partial
loss of use thereof bears to the total loss of use of such
member, or sight of eye, or hearing of an ear.
(a) Loss of hearing for compensation purposes
shall be confined to the frequencies of 1,000, 2,000
and 3,000 cycles per second. Loss of hearing ability
for frequency tones above 3,000 cycles per second are
not to be considered as constituting disability for
hearing.
(b) The percent of hearing loss, for purposes of
the determination of compensation claims for
occupational deafness, shall be calculated as the
average in decibels for the thresholds of hearing for
the frequencies of 1,000, 2,000 and 3,000 cycles per
second. Pure tone air conduction audiometric
instruments, approved by nationally recognized
authorities in this field, shall be used for measuring
hearing loss. If the losses of hearing average 30
decibels or less in the 3 frequencies, such losses of
hearing shall not then constitute any compensable
hearing disability. If the losses of hearing average 85
decibels or more in the 3 frequencies, then the same

SB1309 - 70 - LRB100 08805 JLS 21036 b
shall constitute and be total or 100% compensable
hearing loss.
(c) In measuring hearing impairment, the lowest
measured losses in each of the 3 frequencies shall be
added together and divided by 3 to determine the
average decibel loss. For every decibel of loss
exceeding 30 decibels an allowance of 1.82% shall be
made up to the maximum of 100% which is reached at 85
decibels.
(d) If a hearing loss is established to have
existed on July 1, 1975 by audiometric testing the
employer shall not be liable for the previous loss so
established nor shall he be liable for any loss for
which compensation has been paid or awarded.
(e) No consideration shall be given to the question
of whether or not the ability of an employee to
understand speech is improved by the use of a hearing
aid.
(f) No claim for loss of hearing due to industrial
noise shall be brought against an employer or allowed
unless the employee has been exposed for a period of
time sufficient to cause permanent impairment to noise
levels in excess of the following:
Sound Level DBA
Slow Response Hours Per Day
90 8

SB1309 - 71 - LRB100 08805 JLS 21036 b
92 6
95 4
97 3
100 2
102 1-1/2
105 1
110 1/2
115 1/4
This subparagraph (f) shall not be applied in cases of
hearing loss resulting from trauma or explosion.
17. In computing the compensation to be paid to any
employee who, before the accident for which he claims
compensation, had before that time sustained an injury
resulting in the loss by amputation or partial loss by
amputation of any member, including hand, arm, thumb or
fingers, leg, foot or any toes, such loss or partial loss
of any such member shall be deducted from any award made
for the subsequent injury. For the permanent loss of use or
the permanent partial loss of use of any such member or the
partial loss of sight of an eye, for which compensation has
been paid, then such loss shall be taken into consideration
and deducted from any award for the subsequent injury. For
purposes of this subdivision (e)17 only, "same part of the
spine" means: (1) cervical spine and thoracic spine from
vertebra C1 through T12 and (2) lumbar and sacral spine and
coccyx from vertebra L1 through S5.

SB1309 - 72 - LRB100 08805 JLS 21036 b
18. The specific case of loss of both hands, both arms,
or both feet, or both legs, or both eyes, or of any two
thereof, or the permanent and complete loss of the use
thereof, constitutes total and permanent disability, to be
compensated according to the compensation fixed by
paragraph (f) of this Section. These specific cases of
total and permanent disability do not exclude other cases.
Any employee who has previously suffered the loss or
permanent and complete loss of the use of any of such
members, and in a subsequent independent accident loses
another or suffers the permanent and complete loss of the
use of any one of such members the employer for whom the
injured employee is working at the time of the last
independent accident is liable to pay compensation only for
the loss or permanent and complete loss of the use of the
member occasioned by the last independent accident.
19. In a case of specific loss and the subsequent death
of such injured employee from other causes than such injury
leaving a widow, widower, or dependents surviving before
payment or payment in full for such injury, then the amount
due for such injury is payable to the widow or widower and,
if there be no widow or widower, then to such dependents,
in the proportion which such dependency bears to total
dependency.
Beginning July 1, 1980, and every 6 months thereafter, the
Commission shall examine the Second Injury Fund and when, after

SB1309 - 73 - LRB100 08805 JLS 21036 b
deducting all advances or loans made to such Fund, the amount
therein is $500,000 then the amount required to be paid by
employers pursuant to paragraph (f) of Section 7 shall be
reduced by one-half. When the Second Injury Fund reaches the
sum of $600,000 then the payments shall cease entirely.
However, when the Second Injury Fund has been reduced to
$400,000, payment of one-half of the amounts required by
paragraph (f) of Section 7 shall be resumed, in the manner
herein provided, and when the Second Injury Fund has been
reduced to $300,000, payment of the full amounts required by
paragraph (f) of Section 7 shall be resumed, in the manner
herein provided. The Commission shall make the changes in
payment effective by general order, and the changes in payment
become immediately effective for all cases coming before the
Commission thereafter either by settlement agreement or final
order, irrespective of the date of the accidental injury.
On August 1, 1996 and on February 1 and August 1 of each
subsequent year, the Commission shall examine the special fund
designated as the "Rate Adjustment Fund" and when, after
deducting all advances or loans made to said fund, the amount
therein is $4,000,000, the amount required to be paid by
employers pursuant to paragraph (f) of Section 7 shall be
reduced by one-half. When the Rate Adjustment Fund reaches the
sum of $5,000,000 the payment therein shall cease entirely.
However, when said Rate Adjustment Fund has been reduced to
$3,000,000 the amounts required by paragraph (f) of Section 7

SB1309 - 74 - LRB100 08805 JLS 21036 b
shall be resumed in the manner herein provided.
(f) In case of complete disability, which renders the
employee wholly and permanently incapable of work, or in the
specific case of total and permanent disability as provided in
subparagraph 18 of paragraph (e) of this Section, compensation
shall be payable at the rate provided in subparagraph 2 of
paragraph (b) of this Section for life.
An employee entitled to benefits under paragraph (f) of
this Section shall also be entitled to receive from the Rate
Adjustment Fund provided in paragraph (f) of Section 7 of the
supplementary benefits provided in paragraph (g) of this
Section 8.
If any employee who receives an award under this paragraph
afterwards returns to work or is able to do so, and earns or is
able to earn as much as before the accident, payments under
such award shall cease. If such employee returns to work, or is
able to do so, and earns or is able to earn part but not as much
as before the accident, such award shall be modified so as to
conform to an award under paragraph (d) of this Section. If
such award is terminated or reduced under the provisions of
this paragraph, such employees have the right at any time
within 30 months after the date of such termination or
reduction to file petition with the Commission for the purpose
of determining whether any disability exists as a result of the
original accidental injury and the extent thereof.
Disability as enumerated in subdivision 18, paragraph (e)

SB1309 - 75 - LRB100 08805 JLS 21036 b
of this Section is considered complete disability.
If an employee who had previously incurred loss or the
permanent and complete loss of use of one member, through the
loss or the permanent and complete loss of the use of one hand,
one arm, one foot, one leg, or one eye, incurs permanent and
complete disability through the loss or the permanent and
complete loss of the use of another member, he shall receive,
in addition to the compensation payable by the employer and
after such payments have ceased, an amount from the Second
Injury Fund provided for in paragraph (f) of Section 7, which,
together with the compensation payable from the employer in
whose employ he was when the last accidental injury was
incurred, will equal the amount payable for permanent and
complete disability as provided in this paragraph of this
Section.
The custodian of the Second Injury Fund provided for in
paragraph (f) of Section 7 shall be joined with the employer as
a party respondent in the application for adjustment of claim.
The application for adjustment of claim shall state briefly and
in general terms the approximate time and place and manner of
the loss of the first member.
In its award the Commission or the Arbitrator shall
specifically find the amount the injured employee shall be
weekly paid, the number of weeks compensation which shall be
paid by the employer, the date upon which payments begin out of
the Second Injury Fund provided for in paragraph (f) of Section

SB1309 - 76 - LRB100 08805 JLS 21036 b
7 of this Act, the length of time the weekly payments continue,
the date upon which the pension payments commence and the
monthly amount of the payments. The Commission shall 30 days
after the date upon which payments out of the Second Injury
Fund have begun as provided in the award, and every month
thereafter, prepare and submit to the State Comptroller a
voucher for payment for all compensation accrued to that date
at the rate fixed by the Commission. The State Comptroller
shall draw a warrant to the injured employee along with a
receipt to be executed by the injured employee and returned to
the Commission. The endorsed warrant and receipt is a full and
complete acquittance to the Commission for the payment out of
the Second Injury Fund. No other appropriation or warrant is
necessary for payment out of the Second Injury Fund. The Second
Injury Fund is appropriated for the purpose of making payments
according to the terms of the awards.
As of July 1, 1980 to July 1, 1982, all claims against and
obligations of the Second Injury Fund shall become claims
against and obligations of the Rate Adjustment Fund to the
extent there is insufficient money in the Second Injury Fund to
pay such claims and obligations. In that case, all references
to "Second Injury Fund" in this Section shall also include the
Rate Adjustment Fund.
(g) Every award for permanent total disability entered by
the Commission on and after July 1, 1965 under which
compensation payments shall become due and payable after the

SB1309 - 77 - LRB100 08805 JLS 21036 b
effective date of this amendatory Act, and every award for
death benefits or permanent total disability entered by the
Commission on and after the effective date of this amendatory
Act shall be subject to annual adjustments as to the amount of
the compensation rate therein provided. Such adjustments shall
first be made on July 15, 1977, and all awards made and entered
prior to July 1, 1975 and on July 15 of each year thereafter.
In all other cases such adjustment shall be made on July 15 of
the second year next following the date of the entry of the
award and shall further be made on July 15 annually thereafter.
If during the intervening period from the date of the entry of
the award, or the last periodic adjustment, there shall have
been an increase in the State's average weekly wage in covered
industries under the Unemployment Insurance Act, the weekly
compensation rate shall be proportionately increased by the
same percentage as the percentage of increase in the State's
average weekly wage in covered industries under the
Unemployment Insurance Act. The increase in the compensation
rate under this paragraph shall in no event bring the total
compensation rate to an amount greater than the prevailing
maximum rate at the time that the annual adjustment is made.
Such increase shall be paid in the same manner as herein
provided for payments under the Second Injury Fund to the
injured employee, or his dependents, as the case may be, out of
the Rate Adjustment Fund provided in paragraph (f) of Section 7
of this Act. Payments shall be made at the same intervals as

SB1309 - 78 - LRB100 08805 JLS 21036 b
provided in the award or, at the option of the Commission, may
be made in quarterly payment on the 15th day of January, April,
July and October of each year. In the event of a decrease in
such average weekly wage there shall be no change in the then
existing compensation rate. The within paragraph shall not
apply to cases where there is disputed liability and in which a
compromise lump sum settlement between the employer and the
injured employee, or his dependents, as the case may be, has
been duly approved by the Illinois Workers' Compensation
Commission.
Provided, that in cases of awards entered by the Commission
for injuries occurring before July 1, 1975, the increases in
the compensation rate adjusted under the foregoing provision of
this paragraph (g) shall be limited to increases in the State's
average weekly wage in covered industries under the
Unemployment Insurance Act occurring after July 1, 1975.
For every accident occurring on or after July 20, 2005 but
before the effective date of this amendatory Act of the 94th
General Assembly (Senate Bill 1283 of the 94th General
Assembly), the annual adjustments to the compensation rate in
awards for death benefits or permanent total disability, as
provided in this Act, shall be paid by the employer. The
adjustment shall be made by the employer on July 15 of the
second year next following the date of the entry of the award
and shall further be made on July 15 annually thereafter. If
during the intervening period from the date of the entry of the

SB1309 - 79 - LRB100 08805 JLS 21036 b
award, or the last periodic adjustment, there shall have been
an increase in the State's average weekly wage in covered
industries under the Unemployment Insurance Act, the employer
shall increase the weekly compensation rate proportionately by
the same percentage as the percentage of increase in the
State's average weekly wage in covered industries under the
Unemployment Insurance Act. The increase in the compensation
rate under this paragraph shall in no event bring the total
compensation rate to an amount greater than the prevailing
maximum rate at the time that the annual adjustment is made. In
the event of a decrease in such average weekly wage there shall
be no change in the then existing compensation rate. Such
increase shall be paid by the employer in the same manner and
at the same intervals as the payment of compensation in the
award. This paragraph shall not apply to cases where there is
disputed liability and in which a compromise lump sum
settlement between the employer and the injured employee, or
his or her dependents, as the case may be, has been duly
approved by the Illinois Workers' Compensation Commission.
The annual adjustments for every award of death benefits or
permanent total disability involving accidents occurring
before July 20, 2005 and accidents occurring on or after the
effective date of this amendatory Act of the 94th General
Assembly (Senate Bill 1283 of the 94th General Assembly) shall
continue to be paid from the Rate Adjustment Fund pursuant to
this paragraph and Section 7(f) of this Act.

SB1309 - 80 - LRB100 08805 JLS 21036 b
(h) In case death occurs from any cause before the total
compensation to which the employee would have been entitled has
been paid, then in case the employee leaves any widow, widower,
child, parent (or any grandchild, grandparent or other lineal
heir or any collateral heir dependent at the time of the
accident upon the earnings of the employee to the extent of 50%
or more of total dependency) such compensation shall be paid to
the beneficiaries of the deceased employee and distributed as
provided in paragraph (g) of Section 7.
(h-1) In case an injured employee is under legal disability
at the time when any right or privilege accrues to him or her
under this Act, a guardian may be appointed pursuant to law,
and may, on behalf of such person under legal disability, claim
and exercise any such right or privilege with the same effect
as if the employee himself or herself had claimed or exercised
the right or privilege. No limitations of time provided by this
Act run so long as the employee who is under legal disability
is without a conservator or guardian.
(i) In case the injured employee is under 16 years of age
at the time of the accident and is illegally employed, the
amount of compensation payable under paragraphs (b), (c), (d),
(e) and (f) of this Section is increased 50%.
However, where an employer has on file an employment
certificate issued pursuant to the Child Labor Law or work
permit issued pursuant to the Federal Fair Labor Standards Act,
as amended, or a birth certificate properly and duly issued,

SB1309 - 81 - LRB100 08805 JLS 21036 b
such certificate, permit or birth certificate is conclusive
evidence as to the age of the injured minor employee for the
purposes of this Section.
Nothing herein contained repeals or amends the provisions
of the Child Labor Law relating to the employment of minors
under the age of 16 years.
(j) 1. In the event the injured employee receives benefits,
including medical, surgical or hospital benefits under any
group plan covering non-occupational disabilities contributed
to wholly or partially by the employer, which benefits should
not have been payable if any rights of recovery existed under
this Act, then such amounts so paid to the employee from any
such group plan as shall be consistent with, and limited to,
the provisions of paragraph 2 hereof, shall be credited to or
against any compensation payment for temporary total
incapacity for work or any medical, surgical or hospital
benefits made or to be made under this Act. In such event, the
period of time for giving notice of accidental injury and
filing application for adjustment of claim does not commence to
run until the termination of such payments. This paragraph does
not apply to payments made under any group plan which would
have been payable irrespective of an accidental injury under
this Act. Any employer receiving such credit shall keep such
employee safe and harmless from any and all claims or
liabilities that may be made against him by reason of having
received such payments only to the extent of such credit.

SB1309 - 82 - LRB100 08805 JLS 21036 b
Any excess benefits paid to or on behalf of a State
employee by the State Employees' Retirement System under
Article 14 of the Illinois Pension Code on a death claim or
disputed disability claim shall be credited against any
payments made or to be made by the State of Illinois to or on
behalf of such employee under this Act, except for payments for
medical expenses which have already been incurred at the time
of the award. The State of Illinois shall directly reimburse
the State Employees' Retirement System to the extent of such
credit.
2. Nothing contained in this Act shall be construed to give
the employer or the insurance carrier the right to credit for
any benefits or payments received by the employee other than
compensation payments provided by this Act, and where the
employee receives payments other than compensation payments,
whether as full or partial salary, group insurance benefits,
bonuses, annuities or any other payments, the employer or
insurance carrier shall receive credit for each such payment
only to the extent of the compensation that would have been
payable during the period covered by such payment.
3. The extension of time for the filing of an Application
for Adjustment of Claim as provided in paragraph 1 above shall
not apply to those cases where the time for such filing had
expired prior to the date on which payments or benefits
enumerated herein have been initiated or resumed. Provided
however that this paragraph 3 shall apply only to cases wherein

SB1309 - 83 - LRB100 08805 JLS 21036 b
the payments or benefits hereinabove enumerated shall be
received after July 1, 1969.
(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
disability, the Commission shall base its determination on the
following factors: (i) the reported level of impairment
pursuant to subsection (a), if such a report exists; (ii) the

SB1309 - 84 - LRB100 08805 JLS 21036 b
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. Where an impairment report exists,
it must be considered by the Commission in its determination.
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
approve a Settlement Contract Lump Sum Petition.
(Source: P.A. 97-18, eff. 6-28-11.)
(820 ILCS 305/8.2)
Sec. 8.2. Fee schedule.
(a) Except as provided for in subsection (c), for
procedures, treatments, or services covered under this Act and
rendered or to be rendered on and after February 1, 2006, the
maximum allowable payment shall be 90% of the 80th percentile
of charges and fees as determined by the Commission utilizing
information provided by employers' and insurers' national
databases, with a minimum of 12,000,000 Illinois line item
charges and fees comprised of health care provider and hospital

SB1309 - 85 - LRB100 08805 JLS 21036 b
charges and fees as of August 1, 2004 but not earlier than
August 1, 2002. These charges and fees are provider billed
amounts and shall not include discounted charges. The 80th
percentile is the point on an ordered data set from low to high
such that 80% of the cases are below or equal to that point and
at most 20% are above or equal to that point. The Commission
shall adjust these historical charges and fees as of August 1,
2004 by the Consumer Price Index-U for the period August 1,
2004 through September 30, 2005. The Commission shall establish
fee schedules for procedures, treatments, or services for
hospital inpatient, hospital outpatient, emergency room and
trauma, ambulatory surgical treatment centers, and
professional services. These charges and fees shall be
designated by geozip or any smaller geographic unit. The data
shall in no way identify or tend to identify any patient,
employer, or health care provider. As used in this Section,
"geozip" means a three-digit zip code based on data
similarities, geographical similarities, and frequencies. A
geozip does not cross state boundaries. As used in this
Section, "three-digit zip code" means a geographic area in
which all zip codes have the same first 3 digits. If a geozip
does not have the necessary number of charges and fees to
calculate a valid percentile for a specific procedure,
treatment, or service, the Commission may combine data from the
geozip with up to 4 other geozips that are demographically and
economically similar and exhibit similarities in data and

SB1309 - 86 - LRB100 08805 JLS 21036 b
frequencies until the Commission reaches 9 charges or fees for
that specific procedure, treatment, or service. In cases where
the compiled data contains less than 9 charges or fees for a
procedure, treatment, or service, reimbursement shall occur at
76% of charges and fees as determined by the Commission in a
manner consistent with the provisions of this paragraph.
Providers of out-of-state procedures, treatments, services,
products, or supplies shall be reimbursed at the lesser of that
state's fee schedule amount or the fee schedule amount for the
region in which the employee resides. If no fee schedule exists
in that state, the provider shall be reimbursed at the lesser
of the actual charge or the fee schedule amount for the region
in which the employee resides. Not later than September 30 in
2006 and each year thereafter, the Commission shall
automatically increase or decrease the maximum allowable
payment for a procedure, treatment, or service established and
in effect on January 1 of that year by the percentage change in
the Consumer Price Index-U for the 12 month period ending
August 31 of that year. The increase or decrease shall become
effective on January 1 of the following year. As used in this
Section, "Consumer Price Index-U" means the index published by
the Bureau of Labor Statistics of the U.S. Department of Labor,
that measures the average change in prices of all goods and
services purchased by all urban consumers, U.S. city average,
all items, 1982-84=100.
The provisions of this subsection (a), other than this

SB1309 - 87 - LRB100 08805 JLS 21036 b
sentence, are inoperative after December 31, 2017.
(a-1) Notwithstanding the provisions of subsection (a) and
unless otherwise indicated, the following provisions shall
apply to the medical fee schedule starting on September 1,
2011:
(1) The Commission shall establish and maintain fee
schedules for procedures, treatments, products, services,
or supplies for hospital inpatient, hospital outpatient,
emergency room, ambulatory surgical treatment centers,
accredited ambulatory surgical treatment facilities,
prescriptions filled and dispensed outside of a licensed
pharmacy, dental services, and professional services. This
fee schedule shall be based on the fee schedule amounts
already established by the Commission pursuant to
subsection (a) of this Section. However, starting on
January 1, 2012, these fee schedule amounts shall be
grouped into geographic regions in the following manner:
(A) Four regions for non-hospital fee schedule
amounts shall be utilized:
(i) Cook County;
(ii) DuPage, Kane, Lake, and Will Counties;
(iii) Bond, Calhoun, Clinton, Jersey,
Macoupin, Madison, Monroe, Montgomery, Randolph,
St. Clair, and Washington Counties; and
(iv) All other counties of the State.
(B) Fourteen regions for hospital fee schedule

SB1309 - 88 - LRB100 08805 JLS 21036 b
amounts shall be utilized:
(i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
Kendall, and Grundy Counties;
(ii) Kankakee County;
(iii) Madison, St. Clair, Macoupin, Clinton,
Monroe, Jersey, Bond, and Calhoun Counties;
(iv) Winnebago and Boone Counties;
(v) Peoria, Tazewell, Woodford, Marshall, and
Stark Counties;
(vi) Champaign, Piatt, and Ford Counties;
(vii) Rock Island, Henry, and Mercer Counties;
(viii) Sangamon and Menard Counties;
(ix) McLean County;
(x) Lake County;
(xi) Macon County;
(xii) Vermilion County;
(xiii) Alexander County; and
(xiv) All other counties of the State.
(2) If a geozip, as defined in subsection (a) of this
Section, overlaps into one or more of the regions set forth
in this Section, then the Commission shall average or
repeat the charges and fees in a geozip in order to
designate charges and fees for each region.
(3) In cases where the compiled data contains less than
9 charges or fees for a procedure, treatment, product,
supply, or service or where the fee schedule amount cannot

SB1309 - 89 - LRB100 08805 JLS 21036 b
be determined by the non-discounted charge data,
non-Medicare relative values and conversion factors
derived from established fee schedule amounts, coding
crosswalks, or other data as determined by the Commission,
reimbursement shall occur at 76% of charges and fees until
September 1, 2011 and 53.2% of charges and fees thereafter
as determined by the Commission in a manner consistent with
the provisions of this paragraph.
(4) To establish additional fee schedule amounts, the
Commission shall utilize provider non-discounted charge
data, non-Medicare relative values and conversion factors
derived from established fee schedule amounts, and coding
crosswalks. The Commission may establish additional fee
schedule amounts based on either the charge or cost of the
procedure, treatment, product, supply, or service.
(5) Implants shall be reimbursed at 25% above the net
manufacturer's invoice price less rebates, plus actual
reasonable and customary shipping charges whether or not
the implant charge is submitted by a provider in
conjunction with a bill for all other services associated
with the implant, submitted by a provider on a separate
claim form, submitted by a distributor, or submitted by the
manufacturer of the implant. "Implants" include the
following codes or any substantially similar updated code
as determined by the Commission: 0274
(prosthetics/orthotics); 0275 (pacemaker); 0276 (lens

SB1309 - 90 - LRB100 08805 JLS 21036 b
implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
(investigational devices); and 0636 (drugs requiring
detailed coding). Non-implantable devices or supplies
within these codes shall be reimbursed at 65% of actual
charge, which is the provider's normal rates under its
standard chargemaster. A standard chargemaster is the
provider's list of charges for procedures, treatments,
products, supplies, or services used to bill payers in a
consistent manner.
(6) The Commission shall automatically update all
codes and associated rules with the version of the codes
and rules valid on January 1 of that year.
The provisions of this subsection (a-1), other than this
sentence, are inoperative after December 31, 2017.
(a-1.5) The following provisions shall apply to
procedures, treatments, services, products, and supplies
covered under this Act and rendered or to be rendered on or
after January 1, 2018:
(1) As used in this Section:
"CPT code" means each current procedural
terminology code, for each geographic region specified
in subsection (b) of this Section, included on the most
recent medical fee schedule established by the
Commission pursuant to this Section.
"DRG code" means each current diagnosis related
group code, for each geographic region specified in

SB1309 - 91 - LRB100 08805 JLS 21036 b
subsection (b) of this Section, included on the most
recent medical fee schedule established by the
Commission pursuant to this Section.
"Geozip" means a three-digit zip code based on data
similarities, geographical similarities, and
frequencies.
"Health care services" means those CPT and DRG
codes for procedures, treatments, products, services
or supplies for hospital inpatient, hospital
outpatient, emergency room, ambulatory surgical
treatment centers, accredited ambulatory surgical
treatment facilities, and professional services. It
does not include codes classified as health care common
procedure coding systems or dental.
"Medicare maximum fee" means, for each CPT and DRG
code, the current maximum fee for that CPT or DRG code
allowed to be charged by the Centers for Medicare and
Medicaid Services for Medicare patients in that
geographic region.
"Medicare percentage amount" means, for each CPT
and DRG code, the workers' compensation maximum fee as
a percentage of the Medicare maximum fee.
"Workers' compensation maximum fee" means, for
each CPT and DRG code, the current maximum fee allowed
to be charged under the medical fee schedule
established by the Commission for that CPT or DRG code

SB1309 - 92 - LRB100 08805 JLS 21036 b
in that geographic region.
(2) The Commission shall establish and maintain fee
schedules for procedures, treatments, products, services,
or supplies for hospital inpatient, hospital outpatient,
emergency room, ambulatory surgical treatment centers,
accredited ambulatory surgical treatment facilities,
prescriptions filled and dispensed outside of a licensed
pharmacy, dental services, and professional services.
These fee schedule amounts shall be grouped into geographic
regions in the following manner:
(A) Four regions for non-hospital fee schedule
amounts shall be utilized:
(i) Cook County;
(ii) DuPage, Kane, Lake, and Will Counties;
(iii) Bond, Calhoun, Clinton, Jersey,
Macoupin, Madison, Monroe, Montgomery, Randolph,
St. Clair, and Washington Counties; and
(iv) all other counties of the State.
(B) Fourteen regions for hospital fee schedule
amounts shall be utilized:
(i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
Kendall, and Grundy Counties;
(ii) Kankakee County;
(iii) Madison, St. Clair, Macoupin, Clinton,
Monroe, Jersey, Bond, and Calhoun Counties;
(iv) Winnebago and Boone Counties;

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(v) Peoria, Tazewell, Woodford, Marshall, and
Stark Counties;
(vi) Champaign, Piatt, and Ford Counties;
(vii) Rock Island, Henry, and Mercer Counties;
(viii) Sangamon and Menard Counties;
(ix) McLean County;
(x) Lake County;
(xi) Macon County;
(xii) Vermilion County;
(xiii) Alexander County; and
(xiv) all other counties of the State.
If a geozip overlaps into one or more of the regions
set forth in this Section, then the Commission shall
average or repeat the charges and fees in a geozip in order
to designate charges and fees for each region.
(3) The initial workers' compensation maximum fee for
each CPR and DRG code as of January 1, 2018 shall be
determined as follows:
(A) Within 45 days after the effective date of this
amendatory Act of the 100th General Assembly, the
Commission shall determine the Medicare percentage
amount for each CPT and DRG code using the most recent
data available.
CPT or DRG codes which have a value, but are not
covered expenses under Medicare, are still compensable
under the medical fee schedule according to the rate

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described in subparagraph (B).
(B) Within 30 days after the Commission makes the
determinations required by subparagraph (A), the
Commission shall determine an adjustment to be made to
the then-current workers' compensation maximum fee for
each CPT and DRG code as follows:
(i) If the Medicare percentage amount for that
CPT or DRG code is equal to or less than 125%, then
the workers' compensation maximum fee for that CPT
or DRG code shall be adjusted so that it equals
125% of the most recent Medicare maximum fee for
that CPT or DRG code.
(ii) If the Medicare percentage amount for
that CPT or DRG code is greater than 125% but less
than 150%, then the workers' compensation maximum
fee for that CPT or DRG code shall not be adjusted.
(iii) If the Medicare percentage amount for
that CPT or DRG code is greater than 150% but less
than or equal to 225%, then the workers'
compensation maximum fee for that CPT or DRG code
shall be adjusted so that it equals the greater of
(I) 150% of the most recent Medicare maximum fee
for that CPT or DRG code or (II) 85% of the most
recent workers' compensation maximum amount for
that CPT or DRG code.
(iv) If the Medicare percentage amount for

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that CPT or DRG code is greater than 225% but less
than or equal to 428.57%, then the workers'
compensation maximum fee for that CPT or DRG code
shall be adjusted so that it equals the greater of
(I) 191.25% of the most recent Medicare maximum fee
for that CPT or DRG code or (II) 70% of the most
recent workers' compensation maximum amount for
that CPT or DRG code.
(v) If the Medicare percentage amount for that
CPT or DRG code is greater than 428.57%, then the
workers' compensation maximum fee for that CPT or
DRG code shall be adjusted so that it equals 300%
of the most recent Medicare maximum fee for that
CPT or DRG code.
The Commission shall promptly publish the
adjustments determined pursuant to this subparagraph
(B) on its website.
(C) The initial workers' compensation maximum fee
for each CPT and DRG code as of January 1, 2018 shall
be equal to the workers' compensation maximum fee for
that code as determined and adjusted pursuant to
subparagraph (B), subject to any further adjustments
made pursuant to paragraph (5) of this subsection.
(4)_The Commission, as of January 1, 2019 and January 1
of each year thereafter, shall adjust the workers'
compensation maximum fee for each CPT or DRG code to the

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most recent annual increase in the Consumer Price Index-U.
(5) A person who believes that the workers'
compensation maximum fee for a CPT or DRG code, as
otherwise determined pursuant to this subsection, creates,
or would create upon implementation, a significant
limitation on access to quality health care in either a
specific field of health care services or a specific
geographic limitation on access to health care may petition
the Commission to modify the workers' compensation maximum
fee for that CPT or DRG code so as to not create that
significant limitation.
The petitioner bears the burden of demonstrating, by a
preponderance of the credible evidence, that the workers'
compensation maximum fee that would otherwise apply would
create a significant limitation on access to quality health
care in either a specific field of health care services or
a specific geographic limitation on access to health care.
Petitions shall be made publicly available. Such credible
evidence shall include empirical data demonstrating a
significant limitation on access to quality health care.
Other interested persons may file comments or responses to
a petition within 30 days of the filing of a petition.
The Commission shall take final action on each petition
within 180 days of filing. The Commission may, but is not
required to, seek the recommendation of the Workers'
Compensation Medical Fee Advisory Board to assist with this

SB1309 - 97 - LRB100 08805 JLS 21036 b
determination. If the Commission grants the petition, the
Commission shall further increase the workers'
compensation maximum fee for that CPT or DRG code by the
amount minimally necessary to avoid creating a significant
limitation on access to quality health care in either a
specific field of health care services or a specific
geographic limitation on access to health care. The
increased workers' compensation maximum fee shall take
effect upon entry of the Commission's final action.
(a-2) For procedures, treatments, services, or supplies
covered under this Act and rendered or to be rendered on or
after September 1, 2011, the maximum allowable payment shall be
70% of the fee schedule amounts, which shall be adjusted yearly
by the Consumer Price Index-U, as described in subsection (a)
of this Section. The provisions of this subsection (a-2), other
than this sentence, are inoperative after December 31, 2017.
(a-3) Prescriptions filled and dispensed outside of a
licensed pharmacy shall be subject to a fee schedule that shall
not exceed the Average Wholesale Price (AWP) plus a dispensing
fee of $4.18. AWP or its equivalent as registered by the
National Drug Code shall be set forth for that drug on that
date as published in Medispan.
(a-4) The Commission, in consultation with the Workers'
Compensation Medical Fee Advisory Board, shall adopt, by rule,
an evidence-based drug formulary and any rules necessary for
its administration. Prescriptions prescribed for workers'

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compensation cases shall be limited to those prescription drugs
and doses on the closed formulary.
A request for a prescription that is not on the closed
formulary shall be reviewed pursuant to Section 8.7 of this
Act.
(b) (Blank). Notwithstanding the provisions of subsection
(a), if the Commission finds that there is a significant
limitation on access to quality health care in either a
specific field of health care services or a specific geographic
limitation on access to health care, it may change the Consumer
Price Index-U increase or decrease for that specific field or
specific geographic limitation on access to health care to
address that limitation.
(c) The Commission shall establish by rule a process to
review those medical cases or outliers that involve
extra-ordinary treatment to determine whether to make an
additional adjustment to the maximum payment within a fee
schedule for a procedure, treatment, or service.
(d) When a patient notifies a provider that the treatment,
procedure, or service being sought is for a work-related
illness or injury and furnishes the provider the name and
address of the responsible employer, the provider shall bill
the employer directly. The employer shall make payment and
providers shall submit bills and records in accordance with the
provisions of this Section.
(1) All payments to providers for treatment provided

SB1309 - 99 - LRB100 08805 JLS 21036 b
pursuant to this Act shall be made within 30 days of
receipt of the bills as long as the claim contains
substantially all the required data elements necessary to
adjudicate the bills.
(2) If the claim does not contain substantially all the
required data elements necessary to adjudicate the bill, or
the claim is denied for any other reason, in whole or in
part, the employer or insurer shall provide written
notification, explaining the basis for the denial and
describing any additional necessary data elements, to the
provider within 30 days of receipt of the bill.
(3) In the case of nonpayment to a provider within 30
days of receipt of the bill which contained substantially
all of the required data elements necessary to adjudicate
the bill or nonpayment to a provider of a portion of such a
bill up to the lesser of the actual charge or the payment
level set by the Commission in the fee schedule established
in this Section, the bill, or portion of the bill, shall
incur interest at a rate of 1% per month payable to the
provider. Any required interest payments shall be made
within 30 days after payment.
(e) Except as provided in subsections (e-5), (e-10), and
(e-15), a provider shall not hold an employee liable for costs
related to a non-disputed procedure, treatment, or service
rendered in connection with a compensable injury. The
provisions of subsections (e-5), (e-10), (e-15), and (e-20)

SB1309 - 100 - LRB100 08805 JLS 21036 b
shall not apply if an employee provides information to the
provider regarding participation in a group health plan. If the
employee participates in a group health plan, the provider may
submit a claim for services to the group health plan. If the
claim for service is covered by the group health plan, the
employee's responsibility shall be limited to applicable
deductibles, co-payments, or co-insurance. Except as provided
under subsections (e-5), (e-10), (e-15), and (e-20), a provider
shall not bill or otherwise attempt to recover from the
employee the difference between the provider's charge and the
amount paid by the employer or the insurer on a compensable
injury, or for medical services or treatment determined by the
Commission to be excessive or unnecessary.
(e-5) If an employer notifies a provider that the employer
does not consider the illness or injury to be compensable under
this Act, the provider may seek payment of the provider's
actual charges from the employee for any procedure, treatment,
or service rendered. Once an employee informs the provider that
there is an application filed with the Commission to resolve a
dispute over payment of such charges, the provider shall cease
any and all efforts to collect payment for the services that
are the subject of the dispute. Any statute of limitations or
statute of repose applicable to the provider's efforts to
collect payment from the employee shall be tolled from the date
that the employee files the application with the Commission
until the date that the provider is permitted to resume

SB1309 - 101 - LRB100 08805 JLS 21036 b
collection efforts under the provisions of this Section.
(e-10) If an employer notifies a provider that the employer
will pay only a portion of a bill for any procedure, treatment,
or service rendered in connection with a compensable illness or
disease, the provider may seek payment from the employee for
the remainder of the amount of the bill up to the lesser of the
actual charge, negotiated rate, if applicable, or the payment
level set by the Commission in the fee schedule established in
this Section. Once an employee informs the provider that there
is an application filed with the Commission to resolve a
dispute over payment of such charges, the provider shall cease
any and all efforts to collect payment for the services that
are the subject of the dispute. Any statute of limitations or
statute of repose applicable to the provider's efforts to
collect payment from the employee shall be tolled from the date
that the employee files the application with the Commission
until the date that the provider is permitted to resume
collection efforts under the provisions of this Section.
(e-15) When there is a dispute over the compensability of
or amount of payment for a procedure, treatment, or service,
and a case is pending or proceeding before an Arbitrator or the
Commission, the provider may mail the employee reminders that
the employee will be responsible for payment of any procedure,
treatment or service rendered by the provider. The reminders
must state that they are not bills, to the extent practicable
include itemized information, and state that the employee need

SB1309 - 102 - LRB100 08805 JLS 21036 b
not pay until such time as the provider is permitted to resume
collection efforts under this Section. The reminders shall not
be provided to any credit rating agency. The reminders may
request that the employee furnish the provider with information
about the proceeding under this Act, such as the file number,
names of parties, and status of the case. If an employee fails
to respond to such request for information or fails to furnish
the information requested within 90 days of the date of the
reminder, the provider is entitled to resume any and all
efforts to collect payment from the employee for the services
rendered to the employee and the employee shall be responsible
for payment of any outstanding bills for a procedure,
treatment, or service rendered by a provider.
(e-20) Upon a final award or judgment by an Arbitrator or
the Commission, or a settlement agreed to by the employer and
the employee, a provider may resume any and all efforts to
collect payment from the employee for the services rendered to
the employee and the employee shall be responsible for payment
of any outstanding bills for a procedure, treatment, or service
rendered by a provider as well as the interest awarded under
subsection (d) of this Section. In the case of a procedure,
treatment, or service deemed compensable, the provider shall
not require a payment rate, excluding the interest provisions
under subsection (d), greater than the lesser of the actual
charge or the payment level set by the Commission in the fee
schedule established in this Section. Payment for services

SB1309 - 103 - LRB100 08805 JLS 21036 b
deemed not covered or not compensable under this Act is the
responsibility of the employee unless a provider and employee
have agreed otherwise in writing. Services not covered or not
compensable under this Act are not subject to the fee schedule
in this Section.
(f) Nothing in this Act shall prohibit an employer or
insurer from contracting with a health care provider or group
of health care providers for reimbursement levels for benefits
under this Act different from those provided in this Section.
(g) On or before January 1, 2010 the Commission shall
provide to the Governor and General Assembly a report regarding
the implementation of the medical fee schedule and the index
used for annual adjustment to that schedule as described in
this Section.
(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
standardized forms.
(2) Require acceptance by employers and insurers of
electronic claims for payment of medical services.
(3) Ensure confidentiality of medical information

SB1309 - 104 - LRB100 08805 JLS 21036 b
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.
(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 April 1, 2017 January 1, 2012, and shall
require all employers and insurers to accept electronic claims
for payment of medical services on or before October 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.
(e) The Commission, with assistance from the Department of
Insurance and the Workers' Compensation Medical Fee Advisory

SB1309 - 105 - LRB100 08805 JLS 21036 b
Board, shall publish on its Internet website a companion guide
to assist with compliance with electronic claims rules. The
Workers' Compensation Medical Fee Advisory Board shall
periodically review the companion guide.
(Source: P.A. 97-18, eff. 6-28-11.)
(820 ILCS 305/8.7)
Sec. 8.7. Utilization review programs.
(a) As used in this Section:
"Utilization review" means the evaluation of proposed or
provided health care services to determine the appropriateness
of both the level of health care services medically necessary
and the quality of health care services provided to a patient,
including evaluation of their efficiency, efficacy, and
appropriateness of treatment, hospitalization, or office
visits based on medically accepted standards. The evaluation
must be accomplished by means of a system that identifies the
utilization of health care services based on standards of care
of nationally recognized peer review guidelines as well as
nationally recognized treatment guidelines and evidence-based
medicine based upon standards as provided in this Act.
Utilization techniques may include prospective review, second
opinions, concurrent review, discharge planning, peer review,
independent medical examinations, and retrospective review
(for purposes of this sentence, retrospective review shall be
applicable to services rendered on or after July 20, 2005).

SB1309 - 106 - LRB100 08805 JLS 21036 b
Nothing in this Section applies to prospective review of
necessary first aid or emergency treatment.
(b) No person may conduct a utilization review program for
workers' compensation services in this State unless once every
2 years the person registers the utilization review program
with the Department of Insurance and certifies compliance with
the Workers' Compensation Utilization Management standards or
Health Utilization Management Standards of URAC sufficient to
achieve URAC accreditation or submits evidence of
accreditation by URAC for its Workers' Compensation
Utilization Management Standards or Health Utilization
Management Standards. Nothing in this Act shall be construed to
require an employer or insurer or its subcontractors to become
URAC accredited.
(c) In addition, the Director of Insurance may certify
alternative utilization review standards of national
accreditation organizations or entities in order for plans to
comply with this Section. Any alternative utilization review
standards shall meet or exceed those standards required under
subsection (b).
(d) This registration shall include submission of all of
the following information regarding utilization review program
activities:
(1) The name, address, and telephone number of the
utilization review programs.
(2) The organization and governing structure of the

SB1309 - 107 - LRB100 08805 JLS 21036 b
utilization review programs.
(3) The number of lives for which utilization review is
conducted by each utilization review program.
(4) Hours of operation of each utilization review
program.
(5) Description of the grievance process for each
utilization review program.
(6) Number of covered lives for which utilization
review was conducted for the previous calendar year for
each utilization review program.
(7) Written policies and procedures for protecting
confidential information according to applicable State and
federal laws for each utilization review program.
(e) A utilization review program shall have written
procedures to ensure that patient-specific information
obtained during the process of utilization review will be:
(1) kept confidential in accordance with applicable
State and federal laws; and
(2) shared only with the employee, the employee's
designee, and the employee's health care provider, and
those who are authorized by law to receive the information.
Summary data shall not be considered confidential if it
does not provide information to allow identification of
individual patients or health care providers.
Only a health care professional may make determinations
regarding the medical necessity of health care services during

SB1309 - 108 - LRB100 08805 JLS 21036 b
the course of utilization review.
When making retrospective reviews, utilization review
programs shall base reviews solely on the medical information
available to the attending physician or ordering provider at
the time the health care services were provided.
(f) If the Department of Insurance finds that a utilization
review program is not in compliance with this Section, the
Department shall issue a corrective action plan and allow a
reasonable amount of time for compliance with the plan. If the
utilization review program does not come into compliance, the
Department may issue a cease and desist order. Before issuing a
cease and desist order under this Section, the Department shall
provide the utilization review program with a written notice of
the reasons for the order and allow a reasonable amount of time
to supply additional information demonstrating compliance with
the requirements of this Section and to request a hearing. The
hearing notice shall be sent by certified mail, return receipt
requested, and the hearing shall be conducted in accordance
with the Illinois Administrative Procedure Act.
(g) A utilization review program subject to a corrective
action may continue to conduct business until a final decision
has been issued by the Department.
(h) The Department of Insurance may by rule establish a
registration fee for each person conducting a utilization
review program.
(i) Upon receipt of written notice that the employer or the

SB1309 - 109 - LRB100 08805 JLS 21036 b
employer's agent or insurer wishes to invoke the utilization
review process, the provider of medical, surgical, or hospital
services shall submit to the utilization review, following
accredited procedural guidelines.
(1) The provider shall make reasonable efforts to
provide timely and complete reports of clinical
information needed to support a request for treatment. If
the provider fails to make such reasonable efforts, the
charges for the treatment or service may not be compensable
nor collectible by the provider or claimant from the
employer, the employer's agent, or the employee. The
reporting obligations of providers shall not be
unreasonable or unduly burdensome. The Commission shall by
rule establish an enforcement mechanism to ensure
compliance.
(2) Written notice of utilization review decisions,
including the clinical rationale for certification or
non-certification and references to applicable standards
of care or evidence-based medical guidelines, shall be
furnished to the provider and employee.
(3) An employer may only deny payment of or refuse to
authorize payment of medical services rendered or proposed
to be rendered on the grounds that the extent and scope of
medical treatment is excessive and unnecessary in
compliance with an accredited utilization review program
under this Section.

SB1309 - 110 - LRB100 08805 JLS 21036 b
(4) When a payment for medical services has been denied
or not authorized by an employer or when authorization for
medical services is denied pursuant to utilization review,
the employee has the burden of proof to show by a
preponderance of the evidence that a variance from the
standards of care used by the person or entity performing
the utilization review pursuant to subsection (a) is
reasonably required to cure or relieve the effects of his
or her injury.
(5) The medical professional responsible for review in
the final stage of utilization review or appeal must be
available in this State for interview or deposition; or
must be available for deposition by telephone, video
conference, or other remote electronic means. A medical
professional who works or resides in this State or outside
of this State may comply with this requirement by making
himself or herself available for an interview or deposition
in person or by making himself or herself available by
telephone, video conference, or other remote electronic
means. The remote interview or deposition shall be
conducted in a fair, open, and cost-effective manner. The
expense of interview and the deposition method shall be
paid by the employer. The deponent shall be in the presence
of the officer administering the oath and recording the
deposition, unless otherwise agreed by the parties. Any
exhibits or other demonstrative evidence to be presented to

SB1309 - 111 - LRB100 08805 JLS 21036 b
the deponent by any party at the deposition shall be
provided to the officer administering the oath and all
other parties within a reasonable period of time prior to
the deposition. Nothing shall prohibit any party from being
with the deponent during the deposition, at that party's
expense; provided, however, that a party attending a
deposition shall give written notice of that party's
intention to appear at the deposition to all other parties
within a reasonable time prior to the deposition.
An admissible utilization review shall be considered by the
Commission, along with all other evidence and in the same
manner as all other evidence, and must be addressed along with
all other evidence in the determination of the reasonableness
and necessity of the medical bills or treatment. Nothing in
this Section shall be construed to diminish the rights of
employees to reasonable and necessary medical treatment or
employee choice of health care provider under Section 8(a) or
the rights of employers to medical examinations under Section
12.
(j) When an employer denies payment of or refuses to
authorize payment of first aid, medical, surgical, or hospital
services under Section 8(a) of this Act, if that denial or
refusal to authorize complies with a utilization review program
registered under this Section and complies with all other
requirements of this Section, then there shall be a rebuttable
presumption that the employer shall not be responsible for

SB1309 - 112 - LRB100 08805 JLS 21036 b
payment of additional compensation pursuant to Section 19(k) of
this Act and if that denial or refusal to authorize does not
comply with a utilization review program registered under this
Section and does not comply with all other requirements of this
Section, then that will be considered by the Commission, along
with all other evidence and in the same manner as all other
evidence, in the determination of whether the employer may be
responsible for the payment of additional compensation
pursuant to Section 19(k) of this Act.
(k) For injuries occurring on or after March 1, 2017, an
employee shall be entitled to no more than 24 chiropractic,
occupational therapy, or physical therapy visits per claim.
This limit shall not apply when an employer or insurer
authorizes, in writing, additional visits for chiropractic,
occupational therapy, or physical therapy services. This limit
shall not apply to visits for post-surgical rehabilitation
services.
The changes to this Section made by this amendatory Act of
the 97th General Assembly apply only to health care services
provided or proposed to be provided on or after September 1,
2011.
(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

SB1309 - 113 - LRB100 08805 JLS 21036 b
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 Workers' 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;
(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;

SB1309 - 114 - LRB100 08805 JLS 21036 b
(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.
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

SB1309 - 115 - LRB100 08805 JLS 21036 b
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 June 28, 2011 (the effective
date of Public Act 97-18), including any arbitrators on
administrative leave, shall terminate at the close of business
on July 1, 2011, but the incumbents shall continue to exercise
all of their duties until they are reappointed or their
successors are appointed.
On and after June 28, 2011 (the effective date of Public
Act 97-18), 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

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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 June 28, 2011 (the
effective date of Public Act 97-18) 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
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 Chairman of the
Workers' Compensation 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

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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,
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.

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(Source: P.A. 98-40, eff. 6-28-13; 99-642, eff. 7-28-16.)
(820 ILCS 305/19) (from Ch. 48, par. 138.19)
Sec. 19. Any disputed questions of law or fact shall be
determined as herein provided.
(a) It shall be the duty of the Commission upon
notification that the parties have failed to reach an
agreement, to designate an Arbitrator.
1. Whenever any claimant misconceives his remedy and
files an application for adjustment of claim under this Act
and it is subsequently discovered, at any time before final
disposition of such cause, that the claim for disability or
death which was the basis for such application should
properly have been made under the Workers' Occupational
Diseases Act, then the provisions of Section 19, paragraph
(a-1) of the Workers' Occupational Diseases Act having
reference to such application shall apply.
2. Whenever any claimant misconceives his remedy and
files an application for adjustment of claim under the
Workers' Occupational Diseases Act and it is subsequently
discovered, at any time before final disposition of such
cause that the claim for injury or death which was the
basis for such application should properly have been made
under this Act, then the application so filed under the
Workers' Occupational Diseases Act may be amended in form,
substance or both to assert claim for such disability or

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death under this Act and it shall be deemed to have been so
filed as amended on the date of the original filing
thereof, and such compensation may be awarded as is
warranted by the whole evidence pursuant to this Act. When
such amendment is submitted, further or additional
evidence may be heard by the Arbitrator or Commission when
deemed necessary. Nothing in this Section contained shall
be construed to be or permit a waiver of any provisions of
this Act with reference to notice but notice if given shall
be deemed to be a notice under the provisions of this Act
if given within the time required herein.
3. When an Arbitrator conducts a status call of cases
that appear on the Arbitrator's docket in accordance with
the rules of the Commission, parties or their attorneys may
appear by telephone, video conference, or other remote
electronic means as prescribed by the Commission.
(b) The Arbitrator shall make such inquiries and
investigations as he or they shall deem necessary and may
examine and inspect all books, papers, records, places, or
premises relating to the questions in dispute and hear such
proper evidence as the parties may submit.
The hearings before the Arbitrator shall be held in the
vicinity where the injury occurred after 10 days' notice of the
time and place of such hearing shall have been given to each of
the parties or their attorneys of record.
The Arbitrator may find that the disabling condition is

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temporary and has not yet reached a permanent condition and may
order the payment of compensation up to the date of the
hearing, which award shall be reviewable and enforceable in the
same manner as other awards, and in no instance be a bar to a
further hearing and determination of a further amount of
temporary total compensation or of compensation for permanent
disability, but shall be conclusive as to all other questions
except the nature and extent of said disability.
The decision of the Arbitrator shall be filed with the
Commission which Commission shall immediately send to each
party or his attorney a copy of such decision, together with a
notification of the time when it was filed. As of the effective
date of this amendatory Act of the 94th General Assembly, all
decisions of the Arbitrator shall set forth in writing findings
of fact and conclusions of law, separately stated, if requested
by either party. Unless a petition for review is filed by
either party within 30 days after the receipt by such party of
the copy of the decision and notification of time when filed,
and unless such party petitioning for a review shall within 35
days after the receipt by him of the copy of the decision, file
with the Commission either an agreed statement of the facts
appearing upon the hearing before the Arbitrator, or if such
party shall so elect a correct transcript of evidence of the
proceedings at such hearings, then the decision shall become
the decision of the Commission and in the absence of fraud
shall be conclusive. The Petition for Review shall contain a

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statement of the petitioning party's specific exceptions to the
decision of the arbitrator. The jurisdiction of the Commission
to review the decision of the arbitrator shall not be limited
to the exceptions stated in the Petition for Review. The
Commission, or any member thereof, may grant further time not
exceeding 30 days, in which to file such agreed statement or
transcript of evidence. Such agreed statement of facts or
correct transcript of evidence, as the case may be, shall be
authenticated by the signatures of the parties or their
attorneys, and in the event they do not agree as to the
correctness of the transcript of evidence it shall be
authenticated by the signature of the Arbitrator designated by
the Commission.
Whether the employee is working or not, if the employee is
not receiving or has not received medical, surgical, or
hospital services or other services or compensation as provided
in paragraph (a) of Section 8, or compensation as provided in
paragraph (b) of Section 8, the employee may at any time
petition for an expedited hearing by an Arbitrator on the issue
of whether or not he or she is entitled to receive payment of
the services or compensation. Provided the employer continues
to pay compensation pursuant to paragraph (b) of Section 8, the
employer may at any time petition for an expedited hearing on
the issue of whether or not the employee is entitled to receive
medical, surgical, or hospital services or other services or
compensation as provided in paragraph (a) of Section 8, or

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compensation as provided in paragraph (b) of Section 8. When an
employer has petitioned for an expedited hearing, the employer
shall continue to pay compensation as provided in paragraph (b)
of Section 8 unless the arbitrator renders a decision that the
employee is not entitled to the benefits that are the subject
of the expedited hearing or unless the employee's treating
physician has released the employee to return to work at his or
her regular job with the employer or the employee actually
returns to work at any other job. If the arbitrator renders a
decision that the employee is not entitled to the benefits that
are the subject of the expedited hearing, a petition for review
filed by the employee shall receive the same priority as if the
employee had filed a petition for an expedited hearing by an
Arbitrator. Neither party shall be entitled to an expedited
hearing when the employee has returned to work and the sole
issue in dispute amounts to less than 12 weeks of unpaid
compensation pursuant to paragraph (b) of Section 8.
Expedited hearings shall have priority over all other
petitions and shall be heard by the Arbitrator and Commission
with all convenient speed. Any party requesting an expedited
hearing shall give notice of a request for an expedited hearing
under this paragraph. A copy of the Application for Adjustment
of Claim shall be attached to the notice. The Commission shall
adopt rules and procedures under which the final decision of
the Commission under this paragraph is filed not later than 180
days from the date that the Petition for Review is filed with

SB1309 - 123 - LRB100 08805 JLS 21036 b
the Commission.
Where 2 or more insurance carriers, private self-insureds,
or a group workers' compensation pool under Article V 3/4 of
the Illinois Insurance Code dispute coverage for the same
injury, any such insurance carrier, private self-insured, or
group workers' compensation pool may request an expedited
hearing pursuant to this paragraph to determine the issue of
coverage, provided coverage is the only issue in dispute and
all other issues are stipulated and agreed to and further
provided that all compensation benefits including medical
benefits pursuant to Section 8(a) continue to be paid to or on
behalf of petitioner. Any insurance carrier, private
self-insured, or group workers' compensation pool that is
determined to be liable for coverage for the injury in issue
shall reimburse any insurance carrier, private self-insured,
or group workers' compensation pool that has paid benefits to
or on behalf of petitioner for the injury.
(b-1) If the employee is not receiving medical, surgical or
hospital services as provided in paragraph (a) of Section 8 or
compensation as provided in paragraph (b) of Section 8, the
employee, in accordance with Commission Rules, may file a
petition for an emergency hearing by an Arbitrator on the issue
of whether or not he is entitled to receive payment of such
compensation or services as provided therein. Such petition
shall have priority over all other petitions and shall be heard
by the Arbitrator and Commission with all convenient speed.

SB1309 - 124 - LRB100 08805 JLS 21036 b
Such petition shall contain the following information and
shall be served on the employer at least 15 days before it is
filed:
(i) the date and approximate time of accident;
(ii) the approximate location of the accident;
(iii) a description of the accident;
(iv) the nature of the injury incurred by the employee;
(v) the identity of the person, if known, to whom the
accident was reported and the date on which it was
reported;
(vi) the name and title of the person, if known,
representing the employer with whom the employee conferred
in any effort to obtain compensation pursuant to paragraph
(b) of Section 8 of this Act or medical, surgical or
hospital services pursuant to paragraph (a) of Section 8 of
this Act and the date of such conference;
(vii) a statement that the employer has refused to pay
compensation pursuant to paragraph (b) of Section 8 of this
Act or for medical, surgical or hospital services pursuant
to paragraph (a) of Section 8 of this Act;
(viii) the name and address, if known, of each witness
to the accident and of each other person upon whom the
employee will rely to support his allegations;
(ix) the dates of treatment related to the accident by
medical practitioners, and the names and addresses of such
practitioners, including the dates of treatment related to

SB1309 - 125 - LRB100 08805 JLS 21036 b
the accident at any hospitals and the names and addresses
of such hospitals, and a signed authorization permitting
the employer to examine all medical records of all
practitioners and hospitals named pursuant to this
paragraph;
(x) a copy of a signed report by a medical
practitioner, relating to the employee's current inability
to return to work because of the injuries incurred as a
result of the accident or such other documents or
affidavits which show that the employee is entitled to
receive compensation pursuant to paragraph (b) of Section 8
of this Act or medical, surgical or hospital services
pursuant to paragraph (a) of Section 8 of this Act. Such
reports, documents or affidavits shall state, if possible,
the history of the accident given by the employee, and
describe the injury and medical diagnosis, the medical
services for such injury which the employee has received
and is receiving, the physical activities which the
employee cannot currently perform as a result of any
impairment or disability due to such injury, and the
prognosis for recovery;
(xi) complete copies of any reports, records,
documents and affidavits in the possession of the employee
on which the employee will rely to support his allegations,
provided that the employer shall pay the reasonable cost of
reproduction thereof;

SB1309 - 126 - LRB100 08805 JLS 21036 b
(xii) a list of any reports, records, documents and
affidavits which the employee has demanded by subpoena and
on which he intends to rely to support his allegations;
(xiii) a certification signed by the employee or his
representative that the employer has received the petition
with the required information 15 days before filing.
Fifteen days after receipt by the employer of the petition
with the required information the employee may file said
petition and required information and shall serve notice of the
filing upon the employer. The employer may file a motion
addressed to the sufficiency of the petition. If an objection
has been filed to the sufficiency of the petition, the
arbitrator shall rule on the objection within 2 working days.
If such an objection is filed, the time for filing the final
decision of the Commission as provided in this paragraph shall
be tolled until the arbitrator has determined that the petition
is sufficient.
The employer shall, within 15 days after receipt of the
notice that such petition is filed, file with the Commission
and serve on the employee or his representative a written
response to each claim set forth in the petition, including the
legal and factual basis for each disputed allegation and the
following information: (i) complete copies of any reports,
records, documents and affidavits in the possession of the
employer on which the employer intends to rely in support of
his response, (ii) a list of any reports, records, documents

SB1309 - 127 - LRB100 08805 JLS 21036 b
and affidavits which the employer has demanded by subpoena and
on which the employer intends to rely in support of his
response, (iii) the name and address of each witness on whom
the employer will rely to support his response, and (iv) the
names and addresses of any medical practitioners selected by
the employer pursuant to Section 12 of this Act and the time
and place of any examination scheduled to be made pursuant to
such Section.
Any employer who does not timely file and serve a written
response without good cause may not introduce any evidence to
dispute any claim of the employee but may cross examine the
employee or any witness brought by the employee and otherwise
be heard.
No document or other evidence not previously identified by
either party with the petition or written response, or by any
other means before the hearing, may be introduced into evidence
without good cause. If, at the hearing, material information is
discovered which was not previously disclosed, the Arbitrator
may extend the time for closing proof on the motion of a party
for a reasonable period of time which may be more than 30 days.
No evidence may be introduced pursuant to this paragraph as to
permanent disability. No award may be entered for permanent
disability pursuant to this paragraph. Either party may
introduce into evidence the testimony taken by deposition of
any medical practitioner.
The Commission shall adopt rules, regulations and

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procedures whereby the final decision of the Commission is
filed not later than 90 days from the date the petition for
review is filed but in no event later than 180 days from the
date the petition for an emergency hearing is filed with the
Illinois Workers' Compensation Commission.
All service required pursuant to this paragraph (b-1) must
be by personal service or by certified mail and with evidence
of receipt. In addition for the purposes of this paragraph, all
service on the employer must be at the premises where the
accident occurred if the premises are owned or operated by the
employer. Otherwise service must be at the employee's principal
place of employment by the employer. If service on the employer
is not possible at either of the above, then service shall be
at the employer's principal place of business. After initial
service in each case, service shall be made on the employer's
attorney or designated representative.
(c)(1) At a reasonable time in advance of and in connection
with the hearing under Section 19(e) or 19(h), the Commission
may on its own motion order an impartial physical or mental
examination of a petitioner whose mental or physical condition
is in issue, when in the Commission's discretion it appears
that such an examination will materially aid in the just
determination of the case. The examination shall be made by a
member or members of a panel of physicians chosen for their
special qualifications by the Illinois State Medical Society.
The Commission shall establish procedures by which a physician

SB1309 - 129 - LRB100 08805 JLS 21036 b
shall be selected from such list.
(2) Should the Commission at any time during the hearing
find that compelling considerations make it advisable to have
an examination and report at that time, the commission may in
its discretion so order.
(3) A copy of the report of examination shall be given to
the Commission and to the attorneys for the parties.
(4) Either party or the Commission may call the examining
physician or physicians to testify. Any physician so called
shall be subject to cross-examination.
(5) The examination shall be made, and the physician or
physicians, if called, shall testify, without cost to the
parties. The Commission shall determine the compensation and
the pay of the physician or physicians. The compensation for
this service shall not exceed the usual and customary amount
for such service.
(6) The fees and payment thereof of all attorneys and
physicians for services authorized by the Commission under this
Act shall, upon request of either the employer or the employee
or the beneficiary affected, be subject to the review and
decision of the Commission.
(d) If any employee shall persist in insanitary or
injurious practices which tend to either imperil or retard his
recovery or shall refuse to submit to such medical, surgical,
or hospital treatment as is reasonably essential to promote his
recovery, the Commission may, in its discretion, reduce or

SB1309 - 130 - LRB100 08805 JLS 21036 b
suspend the compensation of any such injured employee. However,
when an employer and employee so agree in writing, the
foregoing provision shall not be construed to authorize the
reduction or suspension of compensation of an employee who is
relying in good faith, on treatment by prayer or spiritual
means alone, in accordance with the tenets and practice of a
recognized church or religious denomination, by a duly
accredited practitioner thereof.
(e) This paragraph shall apply to all hearings before the
Commission. Such hearings may be held in its office or
elsewhere as the Commission may deem advisable. The taking of
testimony on such hearings may be had before any member of the
Commission. If a petition for review and agreed statement of
facts or transcript of evidence is filed, as provided herein,
the Commission shall promptly review the decision of the
Arbitrator and all questions of law or fact which appear from
the statement of facts or transcript of evidence.
In all cases in which the hearing before the arbitrator is
held after December 18, 1989, no additional evidence shall be
introduced by the parties before the Commission on review of
the decision of the Arbitrator. In reviewing decisions of an
arbitrator the Commission shall award such temporary
compensation, permanent compensation and other payments as are
due under this Act. The Commission shall file in its office its
decision thereon, and shall immediately send to each party or
his attorney a copy of such decision and a notification of the

SB1309 - 131 - LRB100 08805 JLS 21036 b
time when it was filed. Decisions shall be filed within 60 days
after the Statement of Exceptions and Supporting Brief and
Response thereto are required to be filed or oral argument
whichever is later.
In the event either party requests oral argument, such
argument shall be had before a panel of 3 members of the
Commission (or before all available members pursuant to the
determination of 7 members of the Commission that such argument
be held before all available members of the Commission)
pursuant to the rules and regulations of the Commission. A
panel of 3 members, which shall be comprised of not more than
one representative citizen of the employing class and not more
than one representative citizen of the employee class, shall
hear the argument; provided that if all the issues in dispute
are solely the nature and extent of the permanent partial
disability, if any, a majority of the panel may deny the
request for such argument and such argument shall not be held;
and provided further that 7 members of the Commission may
determine that the argument be held before all available
members of the Commission. A decision of the Commission shall
be approved by a majority of Commissioners present at such
hearing if any; provided, if no such hearing is held, a
decision of the Commission shall be approved by a majority of a
panel of 3 members of the Commission as described in this
Section. The Commission shall give 10 days' notice to the
parties or their attorneys of the time and place of such taking

SB1309 - 132 - LRB100 08805 JLS 21036 b
of testimony and of such argument.
In any case the Commission in its decision may find
specially upon any question or questions of law or fact which
shall be submitted in writing by either party whether ultimate
or otherwise; provided that on issues other than nature and
extent of the disability, if any, the Commission in its
decision shall find specially upon any question or questions of
law or fact, whether ultimate or otherwise, which are submitted
in writing by either party; provided further that not more than
5 such questions may be submitted by either party. Any party
may, within 20 days after receipt of notice of the Commission's
decision, or within such further time, not exceeding 30 days,
as the Commission may grant, file with the Commission either an
agreed statement of the facts appearing upon the hearing, or,
if such party shall so elect, a correct transcript of evidence
of the additional proceedings presented before the Commission,
in which report the party may embody a correct statement of
such other proceedings in the case as such party may desire to
have reviewed, such statement of facts or transcript of
evidence to be authenticated by the signature of the parties or
their attorneys, and in the event that they do not agree, then
the authentication of such transcript of evidence shall be by
the signature of any member of the Commission.
If a reporter does not for any reason furnish a transcript
of the proceedings before the Arbitrator in any case for use on
a hearing for review before the Commission, within the

SB1309 - 133 - LRB100 08805 JLS 21036 b
limitations of time as fixed in this Section, the Commission
may, in its discretion, order a trial de novo before the
Commission in such case upon application of either party. The
applications for adjustment of claim and other documents in the
nature of pleadings filed by either party, together with the
decisions of the Arbitrator and of the Commission and the
statement of facts or transcript of evidence hereinbefore
provided for in paragraphs (b) and (c) shall be the record of
the proceedings of the Commission, and shall be subject to
review as hereinafter provided.
At the request of either party or on its own motion, the
Commission shall set forth in writing the reasons for the
decision, including findings of fact and conclusions of law
separately stated. The Commission shall by rule adopt a format
for written decisions for the Commission and arbitrators. The
written decisions shall be concise and shall succinctly state
the facts and reasons for the decision. The Commission may
adopt in whole or in part, the decision of the arbitrator as
the decision of the Commission. When the Commission does so
adopt the decision of the arbitrator, it shall do so by order.
Whenever the Commission adopts part of the arbitrator's
decision, but not all, it shall include in the order the
reasons for not adopting all of the arbitrator's decision. When
a majority of a panel, after deliberation, has arrived at its
decision, the decision shall be filed as provided in this
Section without unnecessary delay, and without regard to the

SB1309 - 134 - LRB100 08805 JLS 21036 b
fact that a member of the panel has expressed an intention to
dissent. Any member of the panel may file a dissent. Any
dissent shall be filed no later than 10 days after the decision
of the majority has been filed.
Decisions rendered by the Commission and dissents, if any,
shall be published together by the Commission. The conclusions
of law set out in such decisions shall be regarded as
precedents by arbitrators for the purpose of achieving a more
uniform administration of this Act.
(f) The decision of the Commission acting within its
powers, according to the provisions of paragraph (e) of this
Section shall, in the absence of fraud, be conclusive unless
reviewed as in this paragraph hereinafter provided. However,
the Arbitrator or the Commission may on his or its own motion,
or on the motion of either party, correct any clerical error or
errors in computation within 15 days after the date of receipt
of any award by such Arbitrator or any decision on review of
the Commission and shall have the power to recall the original
award on arbitration or decision on review, and issue in lieu
thereof such corrected award or decision. Where such correction
is made the time for review herein specified shall begin to run
from the date of the receipt of the corrected award or
decision.
(1) Except in cases of claims against the State of
Illinois other than those claims under Section 18.1, in
which case the decision of the Commission shall not be

SB1309 - 135 - LRB100 08805 JLS 21036 b
subject to judicial review, the Circuit Court of the county
where any of the parties defendant may be found, or if none
of the parties defendant can be found in this State then
the Circuit Court of the county where the accident
occurred, shall by summons to the Commission have power to
review all questions of law and fact presented by such
record.
A proceeding for review shall be commenced within 20
days of the receipt of notice of the decision of the
Commission. The summons shall be issued by the clerk of
such court upon written request returnable on a designated
return day, not less than 10 or more than 60 days from the
date of issuance thereof, and the written request shall
contain the last known address of other parties in interest
and their attorneys of record who are to be served by
summons. Service upon any member of the Commission or the
Secretary or the Assistant Secretary thereof shall be
service upon the Commission, and service upon other parties
in interest and their attorneys of record shall be by
summons, and such service shall be made upon the Commission
and other parties in interest by mailing notices of the
commencement of the proceedings and the return day of the
summons to the office of the Commission and to the last
known place of residence of other parties in interest or
their attorney or attorneys of record. The clerk of the
court issuing the summons shall on the day of issue mail

SB1309 - 136 - LRB100 08805 JLS 21036 b
notice of the commencement of the proceedings which shall
be done by mailing a copy of the summons to the office of
the Commission, and a copy of the summons to the other
parties in interest or their attorney or attorneys of
record and the clerk of the court shall make certificate
that he has so sent said notices in pursuance of this
Section, which shall be evidence of service on the
Commission and other parties in interest.
The Commission shall not be required to certify the
record of their proceedings to the Circuit Court, unless
the party commencing the proceedings for review in the
Circuit Court as above provided, shall file with the
Commission notice of intent to file for review in Circuit
Court. It shall be the duty of the Commission upon such
filing of notice of intent to file for review in the
Circuit Court to prepare a true and correct copy of such
testimony and a true and correct copy of all other matters
contained in such record and certified to by the Secretary
or Assistant Secretary thereof. The changes made to this
subdivision (f)(1) by this amendatory Act of the 98th
General Assembly apply to any Commission decision entered
after the effective date of this amendatory Act of the 98th
General Assembly.
No request for a summons may be filed and no summons
shall issue unless the party seeking to review the decision
of the Commission shall exhibit to the clerk of the Circuit

SB1309 - 137 - LRB100 08805 JLS 21036 b
Court proof of filing with the Commission of the notice of
the intent to file for review in the Circuit Court or an
affidavit of the attorney setting forth that notice of
intent to file for review in the Circuit Court has been
given in writing to the Secretary or Assistant Secretary of
the Commission.
(2) No such summons shall issue unless the one against
whom the Commission shall have rendered an award for the
payment of money shall upon the filing of his written
request for such summons file with the clerk of the court a
bond conditioned that if he shall not successfully
prosecute the review, he will pay the award and the costs
of the proceedings in the courts. The amount of the bond
shall be fixed by any member of the Commission and the
surety or sureties of the bond shall be approved by the
clerk of the court. The acceptance of the bond by the clerk
of the court shall constitute evidence of his approval of
the bond.
The State of Illinois, including its constitutional
officers, boards, commissions, agencies, public
institutions of higher learning, and funds administered by
the treasurer ex officio, and every Every county, city,
town, township, incorporated village, school district,
body politic or municipal corporation against whom the
Commission shall have rendered an award for the payment of
money shall not be required to file a bond to secure the

SB1309 - 138 - LRB100 08805 JLS 21036 b
payment of the award and the costs of the proceedings in
the court to authorize the court to issue such summons.
The court may confirm or set aside the decision of the
Commission. If the decision is set aside and the facts
found in the proceedings before the Commission are
sufficient, the court may enter such decision as is
justified by law, or may remand the cause to the Commission
for further proceedings and may state the questions
requiring further hearing, and give such other
instructions as may be proper. Appeals shall be taken to
the Appellate Court in accordance with Supreme Court Rules
22(g) and 303. Appeals shall be taken from the Appellate
Court to the Supreme Court in accordance with Supreme Court
Rule 315.
It shall be the duty of the clerk of any court
rendering a decision affecting or affirming an award of the
Commission to promptly furnish the Commission with a copy
of such decision, without charge.
The decision of a majority of the members of the panel
of the Commission, shall be considered the decision of the
Commission.
(g) Except in the case of a claim against the State of
Illinois, either party may present a certified copy of the
award of the Arbitrator, or a certified copy of the decision of
the Commission when the same has become final, when no
proceedings for review are pending, providing for the payment

SB1309 - 139 - LRB100 08805 JLS 21036 b
of compensation according to this Act, to the Circuit Court of
the county in which such accident occurred or either of the
parties are residents, whereupon the court shall enter a
judgment in accordance therewith. In a case where the employer
refuses to pay compensation according to such final award or
such final decision upon which such judgment is entered the
court shall in entering judgment thereon, tax as costs against
him the reasonable costs and attorney fees in the arbitration
proceedings and in the court entering the judgment for the
person in whose favor the judgment is entered, which judgment
and costs taxed as therein provided shall, until and unless set
aside, have the same effect as though duly entered in an action
duly tried and determined by the court, and shall with like
effect, be entered and docketed. The Circuit Court shall have
power at any time upon application to make any such judgment
conform to any modification required by any subsequent decision
of the Supreme Court upon appeal, or as the result of any
subsequent proceedings for review, as provided in this Act.
Judgment shall not be entered until 15 days' notice of the
time and place of the application for the entry of judgment
shall be served upon the employer by filing such notice with
the Commission, which Commission shall, in case it has on file
the address of the employer or the name and address of its
agent upon whom notices may be served, immediately send a copy
of the notice to the employer or such designated agent.
(h) An agreement or award under this Act providing for

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compensation in installments, may at any time within 18 months
after such agreement or award be reviewed by the Commission at
the request of either the employer or the employee, on the
ground that the disability of the employee has subsequently
recurred, increased, diminished or ended.
However, as to accidents occurring subsequent to July 1,
1955, which are covered by any agreement or award under this
Act providing for compensation in installments made as a result
of such accident, such agreement or award may at any time
within 30 months, or 60 months in the case of an award under
Section 8(d)1, after such agreement or award be reviewed by the
Commission at the request of either the employer or the
employee on the ground that the disability of the employee has
subsequently recurred, increased, diminished or ended.
On such review, compensation payments may be
re-established, increased, diminished or ended. The Commission
shall give 15 days' notice to the parties of the hearing for
review. Any employee, upon any petition for such review being
filed by the employer, shall be entitled to one day's notice
for each 100 miles necessary to be traveled by him in attending
the hearing of the Commission upon the petition, and 3 days in
addition thereto. Such employee shall, at the discretion of the
Commission, also be entitled to 5 cents per mile necessarily
traveled by him within the State of Illinois in attending such
hearing, not to exceed a distance of 300 miles, to be taxed by
the Commission as costs and deposited with the petition of the

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employer.
When compensation which is payable in accordance with an
award or settlement contract approved by the Commission, is
ordered paid in a lump sum by the Commission, no review shall
be had as in this paragraph mentioned.
(i) Each party, upon taking any proceedings or steps
whatsoever before any Arbitrator, Commission or court, shall
file with the Commission his address, or the name and address
of any agent upon whom all notices to be given to such party
shall be served, either personally or by registered mail,
addressed to such party or agent at the last address so filed
with the Commission. In the event such party has not filed his
address, or the name and address of an agent as above provided,
service of any notice may be had by filing such notice with the
Commission.
(j) Whenever in any proceeding testimony has been taken or
a final decision has been rendered and after the taking of such
testimony or after such decision has become final, the injured
employee dies, then in any subsequent proceedings brought by
the personal representative or beneficiaries of the deceased
employee, such testimony in the former proceeding may be
introduced with the same force and effect as though the witness
having so testified were present in person in such subsequent
proceedings and such final decision, if any, shall be taken as
final adjudication of any of the issues which are the same in
both proceedings.

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(k) In case where there has been any unreasonable or
vexatious delay of payment or intentional underpayment of
compensation, or proceedings have been instituted or carried on
by the one liable to pay the compensation, which do not present
a real controversy, but are merely frivolous or for delay, then
the Commission may award compensation additional to that
otherwise payable under this Act equal to 50% of the amount
payable at the time of such award. Failure to pay compensation
in accordance with the provisions of Section 8, paragraph (b)
of this Act, shall be considered unreasonable delay.
When determining whether this subsection (k) shall apply,
the Commission shall consider whether an Arbitrator has
determined that the claim is not compensable or whether the
employer has made payments under Section 8(j).
(k-1) In a case where there has been an unreasonable or
vexatious delay of authorization of medical treatment, the
Commission may award compensation additional to that otherwise
payable under this Act in the sum of $30 per day for each day
that the benefits under Section 8(a) have been so withheld or
refused, not to exceed $10,000 or the total amount due per
Section 8.2 for treatment to be rendered, whichever is less.
Unless utilization review under Section 8.7 or Section 12
examination is, or has been, requested, a delay in
authorization of 14 days or more from the employer's receipt of
all appropriate records and data elements needed to allow the
employer to make a determination whether to authorize such care

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shall create a rebuttable presumption of unreasonable delay.
Authorization of medical treatment does not bind the employer
to payments if it is determined that the employee's care is not
compensable or otherwise payable under the Act.
This subsection (k-1) is the only penalty provision within
the Act applicable to delay of authorization of medical
treatment.
This subsection (k-1) applies only to health care services
provided or proposed to be provided on or after the effective
day of this amendatory Act of the 100th General Assembly.
(l) If the employee has made written demand for payment of
benefits under Section 8(a) or Section 8(b), the employer shall
have 14 days after receipt of the demand to set forth in
writing the reason for the delay. In the case of demand for
payment of medical benefits under Section 8(a), the time for
the employer to respond shall not commence until the expiration
of the allotted 30 days specified under Section 8.2(d). In case
the employer or his or her insurance carrier shall without good
and just cause fail, neglect, refuse, or unreasonably delay the
payment of benefits under Section 8(a) or Section 8(b), the
Arbitrator or the Commission shall allow to the employee
additional compensation in the sum of $30 per day for each day
that the benefits under Section 8(a) or Section 8(b) have been
so withheld or refused, not to exceed $10,000. A delay in
payment of 14 days or more shall create a rebuttable
presumption of unreasonable delay.

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(m) If the commission finds that an accidental injury was
directly and proximately caused by the employer's wilful
violation of a health and safety standard under the Health and
Safety Act or the Occupational Safety and Health Act in force
at the time of the accident, the arbitrator or the Commission
shall allow to the injured employee or his dependents, as the
case may be, additional compensation equal to 25% of the amount
which otherwise would be payable under the provisions of this
Act exclusive of this paragraph. The additional compensation
herein provided shall be allowed by an appropriate increase in
the applicable weekly compensation rate.
(n) After June 30, 1984, decisions of the Illinois Workers'
Compensation Commission reviewing an award of an arbitrator of
the Commission shall draw interest at a rate equal to the yield
on indebtedness issued by the United States Government with a
26-week maturity next previously auctioned on the day on which
the decision is filed. Said rate of interest shall be set forth
in the Arbitrator's Decision. Interest shall be drawn from the
date of the arbitrator's award on all accrued compensation due
the employee through the day prior to the date of payments.
However, when an employee appeals an award of an Arbitrator or
the Commission, and the appeal results in no change or a
decrease in the award, interest shall not further accrue from
the date of such appeal.
The employer or his insurance carrier may tender the
payments due under the award to stop the further accrual of

SB1309 - 145 - LRB100 08805 JLS 21036 b
interest on such award notwithstanding the prosecution by
either party of review, certiorari, appeal to the Supreme Court
or other steps to reverse, vacate or modify the award.
(o) By the 15th day of each month each insurer providing
coverage for losses under this Act shall notify each insured
employer of any compensable claim incurred during the preceding
month and the amounts paid or reserved on the claim including a
summary of the claim and a brief statement of the reasons for
compensability. A cumulative report of all claims incurred
during a calendar year or continued from the previous year
shall be furnished to the insured employer by the insurer
within 30 days after the end of that calendar year.
The insured employer may challenge, in proceeding before
the Commission, payments made by the insurer without
arbitration and payments made after a case is determined to be
noncompensable. If the Commission finds that the case was not
compensable, the insurer shall purge its records as to that
employer of any loss or expense associated with the claim,
reimburse the employer for attorneys' fees arising from the
challenge and for any payment required of the employer to the
Rate Adjustment Fund or the Second Injury Fund, and may not
reflect the loss or expense for rate making purposes. The
employee shall not be required to refund the challenged
payment. The decision of the Commission may be reviewed in the
same manner as in arbitrated cases. No challenge may be
initiated under this paragraph more than 3 years after the

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payment is made. An employer may waive the right of challenge
under this paragraph on a case by case basis.
(p) After filing an application for adjustment of claim but
prior to the hearing on arbitration the parties may voluntarily
agree to submit such application for adjustment of claim for
decision by an arbitrator under this subsection (p) where such
application for adjustment of claim raises only a dispute over
temporary total disability, permanent partial disability or
medical expenses. Such agreement shall be in writing in such
form as provided by the Commission. Applications for adjustment
of claim submitted for decision by an arbitrator under this
subsection (p) shall proceed according to rule as established
by the Commission. The Commission shall promulgate rules
including, but not limited to, rules to ensure that the parties
are adequately informed of their rights under this subsection
(p) and of the voluntary nature of proceedings under this
subsection (p). The findings of fact made by an arbitrator
acting within his or her powers under this subsection (p) in
the absence of fraud shall be conclusive. However, the
arbitrator may on his own motion, or the motion of either
party, correct any clerical errors or errors in computation
within 15 days after the date of receipt of such award of the
arbitrator and shall have the power to recall the original
award on arbitration, and issue in lieu thereof such corrected
award. The decision of the arbitrator under this subsection (p)
shall be considered the decision of the Commission and

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proceedings for review of questions of law arising from the
decision may be commenced by either party pursuant to
subsection (f) of Section 19. The Advisory Board established
under Section 13.1 shall compile a list of certified Commission
arbitrators, each of whom shall be approved by at least 7
members of the Advisory Board. The chairman shall select 5
persons from such list to serve as arbitrators under this
subsection (p). By agreement, the parties shall select one
arbitrator from among the 5 persons selected by the chairman
except that if the parties do not agree on an arbitrator from
among the 5 persons, the parties may, by agreement, select an
arbitrator of the American Arbitration Association, whose fee
shall be paid by the State in accordance with rules promulgated
by the Commission. Arbitration under this subsection (p) shall
be voluntary.
(Source: P.A. 97-18, eff. 6-28-11; 98-40, eff. 6-28-13; 98-874,
eff. 1-1-15.)
(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

SB1309 - 148 - LRB100 08805 JLS 21036 b
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.
(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 amount 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 Department of
Insurance's fraud and insurance non-compliance unit in the

SB1309 - 149 - LRB100 08805 JLS 21036 b
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.
(b) Sentence. Sentences for violations of subsection (a)
are as follows:
(1) A violation of paragraph (a)(3) is a Class 4
felony.
(2) A violation of paragraph (a)(4) or (a)(7) is a
Class 3 felony.
(3) A violation of paragraph (a)(1), (a)(2), (a)(5),
(a)(6), or (a)(9) in which the value of the property
obtained or attempted to be obtained is $500 or less is a
Class A misdemeanor.
(4) A violation of paragraph (a)(1), (a)(2), (a)(5),
(a)(6), or (a)(9) in which the value of the property
obtained or attempted to be obtained is more than $500 but
not more than $10,000 is a Class 3 felony.

SB1309 - 150 - LRB100 08805 JLS 21036 b
(5) A violation of paragraph (a)(1), (a)(2), (a)(5),
(a)(6), or (a)(9) 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.
(6) A violation of paragraph (a)(1), (a)(2), (a)(5),
(a)(6), or (a)(9) in which the value of the property
obtained or attempted to be obtained is more than $100,000
is a Class 1 felony.
(7) A violation of paragraph (8) of subsection (a)
shall be punishable as the class of offense for which the
person convicted assisted, abetted, solicited, or
conspired to commit, as set forth in paragraphs (1) through
(6) of this subsection.
(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.
(8) (5) A person convicted under this Section shall be

SB1309 - 151 - LRB100 08805 JLS 21036 b
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 a violation of paragraph (a)(1) or (a)(2), the value of
the property obtained or attempted to be obtained shall include
payments pursuant to the provisions of this Act as well as the
amount paid for medical expenses. For a violation of paragraph
(a)(5), the value of the property obtained or attempted to be
obtained shall be the difference between the proper amount for
the coverage sought or provided and the actual amount billed
for workers' compensation insurance. For a violation of
paragraph (a)(6), the value of the property obtained or
attempted to be obtained shall be the difference between the
proper amount of security required pursuant to Section 4 of
this Act and the amount furnished pursuant the false or
fraudulent statements or representations. 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 insurance, the
value of the property shall be the fair market replacement
value of the property claimed to be lost, the reasonable costs

SB1309 - 152 - LRB100 08805 JLS 21036 b
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 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.
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

SB1309 - 153 - LRB100 08805 JLS 21036 b
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
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
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

SB1309 - 154 - LRB100 08805 JLS 21036 b
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.
The Department of Insurance's papers, documents, reports,
or evidence relevant to the subject of an investigation under
this Section shall be confidential and not subject to subpoena,
public inspection, or to disclosure under the Freedom of
Information Act for so long as the Director deems reasonably
necessary to complete the investigation, to protect the person
investigated from unwarranted injury, or to be in the public
interest. No officer, agent, or employee of the Department is
subject to subpoena in any civil or administrative action to

SB1309 - 155 - LRB100 08805 JLS 21036 b
testify concerning a matter of which they have knowledge under
a pending fraud or insurance non-compliance investigation by
the Department.
No cause of action exists and no liability may be imposed,
either civil or criminal, against the State, the Director of
Insurance, any officer, agent, or employee of the Department of
Insurance, or individuals employed or retained by the Director
of Insurance, for an act or omission by them in the performance
of a power or duty authorized by this Section, unless the act
or omission was performed in bad faith and with intent to
injure a particular person.
(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
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

SB1309 - 156 - LRB100 08805 JLS 21036 b
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
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

SB1309 - 157 - LRB100 08805 JLS 21036 b
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.
(5) All proceedings under this Section.
(Source: P.A. 97-18, eff. 6-28-11; 97-1150, eff. 1-25-13.)
(820 ILCS 305/29.2)
Sec. 29.2. Insurance and self-insurance oversight.
(a) The Department of Insurance shall annually submit to
the Governor, the Chairman of the Commission, the President of
the Senate, the Speaker of the House of Representatives, the
Minority Leader of the Senate, and the Minority Leader of the

SB1309 - 158 - LRB100 08805 JLS 21036 b
House of Representatives a written report that details the
state of the workers' compensation insurance market in
Illinois. The report shall be completed by April 1 of each
year, beginning in 2012, or later if necessary data or analyses
are only available to the Department at a later date. The
report shall be posted on the Department of Insurance's
Internet website. Information to be included in the report
shall be for the preceding calendar year. The report shall
include, at a minimum, the following:
(1) Gross premiums collected by workers' compensation
carriers in Illinois and the national rank of Illinois
based on premium volume.
(2) The number of insurance companies actively engaged
in Illinois in the workers' compensation insurance market,
including both holding companies and subsidiaries or
affiliates, and the national rank of Illinois based on
number of competing insurers.
(3) The total number of insured participants in the
Illinois workers' compensation assigned risk insurance
pool, and the size of the assigned risk pool as a
proportion of the total Illinois workers' compensation
insurance market.
(4) The advisory organization premium rate for
workers' compensation insurance in Illinois for the
previous year.
(5) The advisory organization prescribed assigned risk

SB1309 - 159 - LRB100 08805 JLS 21036 b
pool premium rate.
(6) The total amount of indemnity payments made by
workers' compensation insurers in Illinois.
(7) The total amount of medical payments made by
workers' compensation insurers in Illinois, and the
national rank of Illinois based on average cost of medical
claims per injured worker.
(8) The gross profitability of workers' compensation
insurers in Illinois, and the national rank of Illinois
based on profitability of workers' compensation insurers.
(9) The loss ratio of workers' compensation insurers in
Illinois and the national rank of Illinois based on the
loss ratio of workers' compensation insurers. For purposes
of this loss ratio calculation, the denominator shall
include all premiums and other fees collected by workers'
compensation insurers and the numerator shall include the
total amount paid by the insurer for care or compensation
to injured workers.
(10) The growth of total paid indemnity benefits by
temporary total disability, scheduled and non-scheduled
permanent partial disability, and total disability.
(11) The number of injured workers receiving wage loss
differential awards and the average wage loss differential
award payout.
(12) Illinois' rank, relative to other states, for:
(i) the maximum and minimum temporary total

SB1309 - 160 - LRB100 08805 JLS 21036 b
disability benefit level;
(ii) the maximum and minimum scheduled and
non-scheduled permanent partial disability benefit
level;
(iii) the maximum and minimum total disability
benefit level; and
(iv) the maximum and minimum death benefit level.
(13) The aggregate growth of medical benefit payout by
non-hospital providers and hospitals.
(14) The aggregate growth of medical utilization for
the top 10 most common injuries to specific body parts by
non-hospital providers and hospitals.
(15) The percentage of injured workers filing claims at
the Commission that are represented by an attorney.
(16) The total amount paid by injured workers for
attorney representation.
(a-5) The Commission shall annually submit to the Governor
and the General Assembly a written report that details the
state of self-insurance for workers' compensation in Illinois.
The report shall be based on information currently collected by
the Commission or the Department of Insurance from
self-insurers, as of the effective date of this amendatory Act
of the 100th General Assembly. The report shall be completed by
December 1, 2017. The report shall be posted on the
Commission's Internet website. Information to be included in
the report shall be for the preceding calendar year. The report

SB1309 - 161 - LRB100 08805 JLS 21036 b
shall include, at a minimum, the following in the aggregate:
(1) The number of employers that self-insure for
workers' compensation.
(2) The total number of employees covered by
self-insurance.
(3) The total amount of indemnity payments made by
self-insureds.
(4) The total amount of medical payments made by
self-insureds.
(5) Illinois' rank, relative to other states, for:
(i) the maximum and minimum temporary total
disability benefit levels;
(ii) the maximum and minimum scheduled and
non-scheduled permanent partial disability benefit
levels;
(iii) the maximum and minimum total disability
benefit levels; and
(iv) the maximum and minimum death benefit levels.
(6) The aggregate growth of medical benefit payouts by
non-hospital providers and hospitals.
Any information collected by the Commission from
self-insureds shall be exempt from public inspection and
disclosure under the Freedom of Information Act.
(b) The Director of Insurance shall promulgate rules
requiring each insurer licensed to write workers' compensation
coverage in the State to record and report the following

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

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