Bill Text: IL HB1698 | 2011-2012 | 97th General Assembly | Enrolled
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Amends the Adoption Act. Provides a form of waiver of parental rights to be used by a putative or legal father of a born or unborn child.
Spectrum: Partisan Bill (Democrat 12-0)
Status: (Passed) 2011-06-28 - Public Act . . . . . . . . . 97-0018 [HB1698 Detail]
Download: Illinois-2011-HB1698-Enrolled.html
Bill Title: Amends the Adoption Act. Provides a form of waiver of parental rights to be used by a putative or legal father of a born or unborn child.
Spectrum: Partisan Bill (Democrat 12-0)
Status: (Passed) 2011-06-28 - Public Act . . . . . . . . . 97-0018 [HB1698 Detail]
Download: Illinois-2011-HB1698-Enrolled.html
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1 | AN ACT concerning civil law.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Department of Central Management Services | ||||||
5 | Law of the
Civil Administrative Code of Illinois is amended by | ||||||
6 | changing Sections 405-105 and 405-411 as follows:
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7 | (20 ILCS 405/405-105) (was 20 ILCS 405/64.1)
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8 | Sec. 405-105. Fidelity, surety, property, and casualty | ||||||
9 | insurance. The Department
shall establish and implement a | ||||||
10 | program to coordinate
the handling of all fidelity, surety, | ||||||
11 | property, and casualty insurance
exposures of the State and the | ||||||
12 | departments, divisions, agencies,
branches,
and universities | ||||||
13 | of the State. In performing this responsibility, the
Department | ||||||
14 | shall have the power and duty to do the following:
| ||||||
15 | (1) Develop and maintain loss and exposure data on all | ||||||
16 | State
property.
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17 | (2) Study the feasibility of establishing a | ||||||
18 | self-insurance plan
for
State property and prepare | ||||||
19 | estimates of the costs of reinsurance for
risks beyond the | ||||||
20 | realistic limits of the self-insurance.
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21 | (3) Prepare a plan for centralizing the purchase of | ||||||
22 | property and
casualty insurance on State property under a | ||||||
23 | master policy or policies
and purchase the insurance |
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| |||||||
1 | contracted for as provided in the
Illinois Purchasing Act.
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2 | (4) Evaluate existing provisions for fidelity bonds | ||||||
3 | required of
State employees and recommend changes that are | ||||||
4 | appropriate
commensurate with risk experience and the | ||||||
5 | determinations respecting
self-insurance or reinsurance so | ||||||
6 | as to permit reduction of costs without
loss of coverage.
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7 | (5) Investigate procedures for inclusion of school | ||||||
8 | districts,
public community
college districts, and other | ||||||
9 | units of local government in programs for
the centralized | ||||||
10 | purchase of insurance.
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11 | (6) Implement recommendations of the State Property
| ||||||
12 | Insurance
Study Commission that the Department finds | ||||||
13 | necessary or desirable in
the
performance of its powers and | ||||||
14 | duties under this Section to achieve
efficient and | ||||||
15 | comprehensive risk management.
| ||||||
16 | (7) Prepare and, in the discretion of the Director, | ||||||
17 | implement a plan providing for the purchase of public
| ||||||
18 | liability insurance or for self-insurance for public | ||||||
19 | liability or for a
combination of purchased insurance and | ||||||
20 | self-insurance for public
liability (i) covering the State | ||||||
21 | and drivers of motor vehicles
owned,
leased, or controlled | ||||||
22 | by the State of Illinois pursuant to the provisions
and | ||||||
23 | limitations contained in the Illinois Vehicle Code, (ii)
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24 | covering
other public liability exposures of the State and | ||||||
25 | its employees within
the scope of their employment, and | ||||||
26 | (iii) covering drivers of motor
vehicles not owned, leased, |
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1 | or controlled by the State but used by a
State employee on | ||||||
2 | State business, in excess of liability covered by an
| ||||||
3 | insurance policy obtained by the owner of the motor vehicle | ||||||
4 | or in
excess of the dollar amounts that the Department | ||||||
5 | shall
determine to be
reasonable. Any contract of insurance | ||||||
6 | let under this Law shall be
by
bid in accordance with the | ||||||
7 | procedure set forth in the Illinois
Purchasing Act. Any | ||||||
8 | provisions for self-insurance shall conform to
subdivision | ||||||
9 | (11).
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10 | The term "employee" as used in this subdivision (7) and | ||||||
11 | in subdivision
(11)
means a person while in the employ of | ||||||
12 | the State who is a member of the
staff or personnel of a | ||||||
13 | State agency, bureau, board, commission,
committee, | ||||||
14 | department, university, or college or who is a State | ||||||
15 | officer,
elected official, commissioner, member of or ex | ||||||
16 | officio member of a
State agency, bureau, board, | ||||||
17 | commission, committee, department,
university, or college, | ||||||
18 | or a member of the National Guard while on active
duty | ||||||
19 | pursuant to orders of the Governor of the State of | ||||||
20 | Illinois, or any
other person while using a licensed motor | ||||||
21 | vehicle owned, leased, or
controlled by the State of | ||||||
22 | Illinois with the authorization of the State
of Illinois, | ||||||
23 | provided the actual use of the motor vehicle is
within the | ||||||
24 | scope of that
authorization and within the course of State | ||||||
25 | service.
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26 | Subsequent to payment of a claim on behalf of an |
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1 | employee pursuant to this
Section and after reasonable | ||||||
2 | advance written notice to the employee, the
Director may | ||||||
3 | exclude the employee from future coverage or limit the
| ||||||
4 | coverage under the plan if (i) the Director determines that | ||||||
5 | the
claim
resulted from an incident in which the employee | ||||||
6 | was grossly negligent or
had engaged in willful and wanton | ||||||
7 | misconduct or (ii) the
Director
determines that the | ||||||
8 | employee is no longer an acceptable risk based on a
review | ||||||
9 | of prior accidents in which the employee was at fault and | ||||||
10 | for which
payments were made pursuant to this Section.
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11 | The Director is authorized to
promulgate | ||||||
12 | administrative rules that may be necessary to
establish and
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13 | administer the plan.
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14 | Appropriations from the Road Fund shall be used to pay | ||||||
15 | auto liability claims
and related expenses involving | ||||||
16 | employees of the Department of Transportation,
the | ||||||
17 | Illinois State Police, and the Secretary of State.
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18 | (8) Charge, collect, and receive from all other | ||||||
19 | agencies of
the State
government fees or monies equivalent | ||||||
20 | to the cost of purchasing the insurance.
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21 | (9) Establish, through the Director, charges for risk
| ||||||
22 | management
services
rendered to State agencies by the | ||||||
23 | Department.
The State agencies so charged shall reimburse | ||||||
24 | the Department by vouchers drawn
against their respective
| ||||||
25 | appropriations. The reimbursement shall be determined by | ||||||
26 | the Director as
amounts sufficient to reimburse the |
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1 | Department
for expenditures incurred in rendering the | ||||||
2 | service.
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3 | The Department shall charge the
employing State agency | ||||||
4 | or university for workers' compensation payments for
| ||||||
5 | temporary total disability paid to any employee after the | ||||||
6 | employee has
received temporary total disability payments | ||||||
7 | for 120 days if the employee's
treating physician has | ||||||
8 | issued a release to return to work with restrictions
and | ||||||
9 | the employee is able to perform modified duty work but the | ||||||
10 | employing
State agency or
university does not return the | ||||||
11 | employee to work at modified duty. Modified
duty shall be | ||||||
12 | duties assigned that may or may not be delineated
as part | ||||||
13 | of the duties regularly performed by the employee. Modified | ||||||
14 | duties
shall be assigned within the prescribed | ||||||
15 | restrictions established by the
treating physician and the | ||||||
16 | physician who performed the independent medical
| ||||||
17 | examination. The amount of all reimbursements
shall be | ||||||
18 | deposited into the Workers' Compensation Revolving Fund | ||||||
19 | which is
hereby created as a revolving fund in the State | ||||||
20 | treasury. In addition to any other purpose authorized by | ||||||
21 | law, moneys in the Fund
shall be used, subject to | ||||||
22 | appropriation, to pay these or other temporary
total | ||||||
23 | disability claims of employees of State agencies and | ||||||
24 | universities.
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25 | Beginning with fiscal year 1996, all amounts recovered | ||||||
26 | by the
Department through subrogation in workers' |
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1 | compensation and workers'
occupational disease cases shall | ||||||
2 | be
deposited into the Workers' Compensation Revolving Fund | ||||||
3 | created under
this subdivision (9).
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4 | (10) Establish rules, procedures, and forms to be used | ||||||
5 | by
State agencies
in the administration and payment of | ||||||
6 | workers' compensation claims.
The Department shall | ||||||
7 | initially evaluate and determine the compensability of
any | ||||||
8 | injury that is
the subject of a workers' compensation claim | ||||||
9 | and provide for the
administration and payment of such a | ||||||
10 | claim for all State agencies. The
Director may delegate to | ||||||
11 | any agency with the agreement of the agency head
the | ||||||
12 | responsibility for evaluation, administration, and payment | ||||||
13 | of that
agency's claims.
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14 | (10a) If the Director determines it would be in the | ||||||
15 | best interests of the State and its employees, prepare and | ||||||
16 | implement a plan providing for: (i) the purchase of | ||||||
17 | workers' compensation insurance for workers' compensation | ||||||
18 | liability; (ii) third-party administration of | ||||||
19 | self-insurance, in whole or in part, for workers' | ||||||
20 | compensation liability; or (iii) a combination of | ||||||
21 | purchased insurance and self-insurance for workers' | ||||||
22 | compensation liability, including reinsurance or stop-loss | ||||||
23 | insurance. Any contract for insurance or third-party | ||||||
24 | administration shall be on terms consistent with State | ||||||
25 | policy; awarded in compliance with the Illinois | ||||||
26 | Procurement Code; and based on, but not limited to, the |
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1 | following criteria: administrative cost, service | ||||||
2 | capabilities of the carrier or other contractor and | ||||||
3 | premiums, fees, or charges. By April 1 of each year, the | ||||||
4 | Director must report and provide information to the State | ||||||
5 | Workers' Compensation Program Advisory Board concerning | ||||||
6 | the status of the State workers' compensation program for | ||||||
7 | the next fiscal year. Information includes, but is not | ||||||
8 | limited to, documents, reports of negotiations, bid | ||||||
9 | invitations, requests for proposals, specifications, | ||||||
10 | copies of proposed and final contracts or agreements, and | ||||||
11 | any other materials concerning contracts or agreements for | ||||||
12 | the program. By the first of each month thereafter, the | ||||||
13 | Director must provide updated, and any new, information to | ||||||
14 | the State Workers' Compensation Program Advisory Board | ||||||
15 | until the State workers' compensation program for the next | ||||||
16 | fiscal year is determined. | ||||||
17 | (11) Any plan for public liability self-insurance | ||||||
18 | implemented
under this
Section shall provide that (i) the | ||||||
19 | Department
shall attempt to settle and may settle any | ||||||
20 | public liability claim filed
against the State of Illinois | ||||||
21 | or any public liability claim filed
against a State | ||||||
22 | employee on the basis of an occurrence in the course of
the | ||||||
23 | employee's State employment; (ii) any settlement of
such a | ||||||
24 | claim is not subject to fiscal year limitations and must be
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25 | approved by the Director and, in cases of
settlements | ||||||
26 | exceeding $100,000, by the Governor; and (iii) a
settlement |
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1 | of
any public liability claim against the State or a State | ||||||
2 | employee shall
require an unqualified release of any right | ||||||
3 | of action against the State
and the employee for acts | ||||||
4 | within the scope of the employee's employment
giving rise | ||||||
5 | to the claim.
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6 | Whenever and to the extent that a State
employee | ||||||
7 | operates a motor vehicle or engages in other activity | ||||||
8 | covered
by self-insurance under this Section, the State of | ||||||
9 | Illinois shall
defend, indemnify, and hold harmless the | ||||||
10 | employee against any claim in
tort filed against the | ||||||
11 | employee for acts or omissions within the scope
of the | ||||||
12 | employee's employment in any proper judicial forum and not
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13 | settled pursuant
to this subdivision (11), provided that | ||||||
14 | this obligation of
the State of
Illinois shall not exceed a | ||||||
15 | maximum liability of $2,000,000 for any
single occurrence | ||||||
16 | in connection with the operation of a motor vehicle or
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17 | $100,000 per person per occurrence for any other single | ||||||
18 | occurrence,
or $500,000 for any single occurrence in | ||||||
19 | connection with the provision of
medical care by a licensed | ||||||
20 | physician employee.
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21 | Any
claims against the State of Illinois under a | ||||||
22 | self-insurance plan that
are not settled pursuant to this | ||||||
23 | subdivision (11) shall be
heard and
determined by the Court | ||||||
24 | of Claims and may not be filed or adjudicated
in any other | ||||||
25 | forum. The Attorney General of the State of Illinois or
the | ||||||
26 | Attorney General's designee shall be the attorney with |
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1 | respect
to all public liability
self-insurance claims that | ||||||
2 | are not settled pursuant to this
subdivision (11)
and | ||||||
3 | therefore result in litigation. The payment of any award of | ||||||
4 | the
Court of Claims entered against the State relating to | ||||||
5 | any public
liability self-insurance claim shall act as a | ||||||
6 | release against any State
employee involved in the | ||||||
7 | occurrence.
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8 | (12) Administer a plan the purpose of which is to make | ||||||
9 | payments
on final
settlements or final judgments in | ||||||
10 | accordance with the State Employee
Indemnification Act. | ||||||
11 | The plan shall be funded through appropriations from the
| ||||||
12 | General Revenue Fund specifically designated for that | ||||||
13 | purpose, except that
indemnification expenses for | ||||||
14 | employees of the Department of Transportation,
the | ||||||
15 | Illinois State Police, and the Secretary of State
shall be | ||||||
16 | paid
from the Road
Fund. The term "employee" as used in | ||||||
17 | this subdivision (12) has the same
meaning as under | ||||||
18 | subsection (b) of Section 1 of the State Employee
| ||||||
19 | Indemnification Act. Subject to sufficient appropriation, | ||||||
20 | the Director shall approve payment of any claim, without | ||||||
21 | regard to fiscal year limitations, presented to
the | ||||||
22 | Director
that is supported by a final settlement or final | ||||||
23 | judgment when the Attorney
General and the chief officer of | ||||||
24 | the public body against whose employee the
claim or cause | ||||||
25 | of action is asserted certify to the Director that
the | ||||||
26 | claim is in
accordance with the State Employee |
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1 | Indemnification Act and that they
approve
of the payment. | ||||||
2 | In no event shall an amount in excess of $150,000 be paid | ||||||
3 | from
this plan to or for the benefit of any claimant.
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4 | (13) Administer a plan the purpose of which is to make | ||||||
5 | payments
on final
settlements or final judgments for | ||||||
6 | employee wage claims in situations where
there was an | ||||||
7 | appropriation relevant to the wage claim, the fiscal year
| ||||||
8 | and lapse period have expired, and sufficient funds were | ||||||
9 | available
to
pay the claim. The plan shall be funded | ||||||
10 | through
appropriations from the General Revenue Fund | ||||||
11 | specifically designated for
that purpose.
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12 | Subject to sufficient appropriation, the Director is | ||||||
13 | authorized to pay any wage claim presented to the
Director
| ||||||
14 | that is supported by a final settlement or final judgment | ||||||
15 | when the chief
officer of the State agency employing the | ||||||
16 | claimant certifies to the
Director that
the claim is a | ||||||
17 | valid wage claim and that the fiscal year and lapse period
| ||||||
18 | have expired. Payment for claims that are properly | ||||||
19 | submitted and certified
as valid by the Director
shall | ||||||
20 | include interest accrued at the rate of 7% per annum from | ||||||
21 | the
forty-fifth day after the claims are received by the | ||||||
22 | Department or 45 days from the date on which the amount of | ||||||
23 | payment
is agreed upon, whichever is later, until the date | ||||||
24 | the claims are submitted
to the Comptroller for payment. | ||||||
25 | When the Attorney General has filed an
appearance in any | ||||||
26 | proceeding concerning a wage claim settlement or
judgment, |
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1 | the Attorney General shall certify to the Director that the | ||||||
2 | wage claim is valid before any payment is
made. In no event | ||||||
3 | shall an amount in excess of $150,000 be paid from this
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4 | plan to or for the benefit of any claimant.
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5 | Nothing in Public Act 84-961 shall be construed to | ||||||
6 | affect in any manner the jurisdiction of the
Court of | ||||||
7 | Claims concerning wage claims made against the State of | ||||||
8 | Illinois.
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9 | (14) Prepare and, in the discretion of the Director, | ||||||
10 | implement a program for
self-insurance for official
| ||||||
11 | fidelity and surety bonds for officers and employees as | ||||||
12 | authorized by the
Official Bond Act.
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13 | (Source: P.A. 96-928, eff. 6-15-10.)
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14 | (20 ILCS 405/405-411) | ||||||
15 | Sec. 405-411. Consolidation of workers' compensation | ||||||
16 | functions. | ||||||
17 | (a) Notwithstanding any other law to the contrary, the | ||||||
18 | Director of Central Management Services, working in | ||||||
19 | cooperation with the Director of any other agency, department, | ||||||
20 | board, or commission directly responsible to the Governor, may | ||||||
21 | direct the consolidation, within the Department of Central | ||||||
22 | Management Services, of those workers' compensation functions | ||||||
23 | at that agency, department, board, or commission that are | ||||||
24 | suitable for centralization. | ||||||
25 | Upon receipt of the written direction to transfer workers' |
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1 | compensation functions to the Department of Central Management | ||||||
2 | Services, the personnel, equipment, and property (both real and | ||||||
3 | personal) directly relating to the transferred functions shall | ||||||
4 | be transferred to the Department of Central Management | ||||||
5 | Services, and the relevant documents, records, and | ||||||
6 | correspondence shall be transferred or copied, as the Director | ||||||
7 | may prescribe. | ||||||
8 | (b) Upon receiving written direction from the Director of | ||||||
9 | Central Management Services, the Comptroller and Treasurer are | ||||||
10 | authorized to transfer the unexpended balance of any | ||||||
11 | appropriations related to the workers' compensation functions | ||||||
12 | transferred to the Department of Central Management Services | ||||||
13 | and shall make the necessary fund transfers from the General | ||||||
14 | Revenue Fund, any special fund in the State treasury, or any | ||||||
15 | other federal or State trust fund held by the Treasurer to the | ||||||
16 | Workers' Compensation Revolving Fund for use by the Department | ||||||
17 | of Central Management Services in support of workers' | ||||||
18 | compensation functions or any other related costs or expenses | ||||||
19 | of the Department of Central Management Services. | ||||||
20 | (c) The rights of employees and the State and its agencies | ||||||
21 | under the Personnel Code and applicable collective bargaining | ||||||
22 | agreements or under any pension, retirement, or annuity plan | ||||||
23 | shall not be affected by any transfer under this Section. | ||||||
24 | (d) The functions transferred to the Department of Central | ||||||
25 | Management Services by this Section shall be vested in and | ||||||
26 | shall be exercised by the Department of Central Management |
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1 | Services. Each act done in the exercise of those functions | ||||||
2 | shall have the same legal effect as if done by the agencies, | ||||||
3 | offices, divisions, departments, bureaus, boards and | ||||||
4 | commissions from which they were transferred. | ||||||
5 | Every person or other entity shall be subject to the same | ||||||
6 | obligations and duties and any penalties, civil or criminal, | ||||||
7 | arising therefrom, and shall have the same rights arising from | ||||||
8 | the exercise of such rights, powers, and duties as had been | ||||||
9 | exercised by the agencies, offices, divisions, departments, | ||||||
10 | bureaus, boards, and commissions from which they were | ||||||
11 | transferred. | ||||||
12 | Whenever reports or notices are now required to be made or | ||||||
13 | given or papers or documents furnished or served by any person | ||||||
14 | in regards to the functions transferred to or upon the | ||||||
15 | agencies, offices, divisions, departments, bureaus, boards, | ||||||
16 | and commissions from which the functions were transferred, the | ||||||
17 | same shall be made, given, furnished or served in the same | ||||||
18 | manner to or upon the Department of Central Management | ||||||
19 | Services. | ||||||
20 | This Section does not affect any act done, ratified, or | ||||||
21 | cancelled or any right occurring or established or any action | ||||||
22 | or proceeding had or commenced in an administrative, civil, or | ||||||
23 | criminal cause regarding the functions transferred, but those | ||||||
24 | proceedings may be continued by the Department of Central | ||||||
25 | Management Services. | ||||||
26 | This Section does not affect the legality of any rules in |
| |||||||
| |||||||
1 | the Illinois Administrative Code regarding the functions | ||||||
2 | transferred in this Section that are in force on the effective | ||||||
3 | date of this Section. If necessary, however, the affected | ||||||
4 | agencies shall propose, adopt, or repeal rules, rule | ||||||
5 | amendments, and rule recodifications as appropriate to | ||||||
6 | effectuate this Section.
| ||||||
7 | (e) There is hereby created within the Department of | ||||||
8 | Central Management Services an advisory body to be known as the | ||||||
9 | State Workers' Compensation Program Advisory Board to review, | ||||||
10 | assess, and provide recommendations to improve the State | ||||||
11 | workers' compensation program and to ensure that the State | ||||||
12 | manages the program in the interests of injured workers and | ||||||
13 | taxpayers. The Governor shall appoint one person to the Board, | ||||||
14 | who shall serve as the Chairperson. The Speaker of the House of | ||||||
15 | Representatives, the Minority Leader of the House of | ||||||
16 | Representatives, the President of the Senate, and the Minority | ||||||
17 | Leader of the Senate shall each appoint one person to the | ||||||
18 | Board. Each member initially appointed to the Board shall serve | ||||||
19 | a term ending December 31, 2013, and each Board member | ||||||
20 | appointed thereafter shall serve a 3-year term. A Board member | ||||||
21 | shall continue to serve on the Board until his or her successor | ||||||
22 | is appointed. In addition, the Director of the Department of | ||||||
23 | Central Management Services, the Attorney General, the | ||||||
24 | Director of the Department of Insurance, the Secretary of the | ||||||
25 | Department of Transportation, the Director of the Department of | ||||||
26 | Corrections, the Secretary of the Department of Human Services, |
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1 | the Director of the Department of Revenue, and the Chairman of | ||||||
2 | the Illinois Workers' Compensation Commission, or their | ||||||
3 | designees, shall serve as ex officio, non-voting members of the | ||||||
4 | Board. Members of the Board shall not receive compensation but | ||||||
5 | shall be reimbursed from the Workers' Compensation Revolving | ||||||
6 | Fund for reasonable expenses incurred in the necessary | ||||||
7 | performance of their duties, and the Department of Central | ||||||
8 | Management Services shall provide administrative support to | ||||||
9 | the Board. The Board shall meet at least 3 times per year or | ||||||
10 | more often if the Board deems it necessary or proper. By | ||||||
11 | September 30, 2011, the Board shall issue a written report, to | ||||||
12 | be delivered to the Governor, the Director of the Department of | ||||||
13 | Central Management Services, and the General Assembly, with a | ||||||
14 | recommended set of best practices for the State workers' | ||||||
15 | compensation program. By July 1 of each year thereafter, the | ||||||
16 | Board shall issue a written report, to be delivered to those | ||||||
17 | same persons or entities, with recommendations on how to | ||||||
18 | improve upon such practices. | ||||||
19 | (Source: P.A. 93-839, eff. 7-30-04.)
| ||||||
20 | Section 10. The Code of Civil Procedure is amended by | ||||||
21 | changing Section 8-802 as follows:
| ||||||
22 | (735 ILCS 5/8-802) (from Ch. 110, par. 8-802)
| ||||||
23 | Sec. 8-802. Physician and patient. No physician or surgeon | ||||||
24 | shall be
permitted to disclose any information he or she may |
| |||||||
| |||||||
1 | have acquired in
attending any patient in a professional | ||||||
2 | character, necessary to enable him
or her professionally to | ||||||
3 | serve the patient, except only (1) in trials for
homicide when | ||||||
4 | the disclosure relates directly to the fact or immediate
| ||||||
5 | circumstances of the homicide, (2) in actions, civil or | ||||||
6 | criminal, against
the physician for malpractice, (3) with the | ||||||
7 | expressed consent of the
patient, or in case of his or her | ||||||
8 | death or disability, of his or her
personal representative or | ||||||
9 | other person authorized to sue for personal
injury or of the | ||||||
10 | beneficiary of an insurance policy on his or her life,
health, | ||||||
11 | or physical condition, (4) in all actions brought by or against | ||||||
12 | the
patient, his or her personal representative, a beneficiary | ||||||
13 | under a policy
of insurance, or the executor or administrator | ||||||
14 | of his or her estate wherein
the patient's physical or mental | ||||||
15 | condition is an issue, (5) upon an issue
as to the validity of | ||||||
16 | a document as a will of the patient, (6) in any
criminal action | ||||||
17 | where the charge is either first degree murder by abortion,
| ||||||
18 | attempted abortion or abortion, (7) in actions, civil or | ||||||
19 | criminal, arising
from the filing of a report in compliance | ||||||
20 | with the Abused and Neglected
Child Reporting Act, (8) to any | ||||||
21 | department, agency, institution
or facility which has custody | ||||||
22 | of the patient pursuant to State statute
or any court order of | ||||||
23 | commitment, (9) in prosecutions where written
results of blood | ||||||
24 | alcohol tests are admissible pursuant to Section 11-501.4
of | ||||||
25 | the Illinois Vehicle Code, (10) in prosecutions where written
| ||||||
26 | results of blood alcohol tests are admissible under Section |
| |||||||
| |||||||
1 | 5-11a of the
Boat Registration and Safety Act,
(11) in criminal | ||||||
2 | actions arising from the filing of a report of suspected
| ||||||
3 | terrorist offense in compliance with Section 29D-10(p)(7) of | ||||||
4 | the Criminal Code
of 1961, or (12) upon the issuance of a | ||||||
5 | subpoena pursuant to Section 38 of the Medical Practice Act of | ||||||
6 | 1987; the issuance of a subpoena pursuant to Section 25.1 of | ||||||
7 | the Illinois Dental Practice Act; or the issuance of a subpoena | ||||||
8 | pursuant to Section 22 of the Nursing Home Administrators | ||||||
9 | Licensing and Disciplinary Act ; or the issuance of a subpoena | ||||||
10 | pursuant to Section 25.5 of the Workers' Compensation Act .
| ||||||
11 | In the event of a conflict between the application of this | ||||||
12 | Section
and the Mental Health and Developmental Disabilities | ||||||
13 | Confidentiality
Act to a specific situation, the provisions of | ||||||
14 | the Mental Health and
Developmental Disabilities | ||||||
15 | Confidentiality Act shall control.
| ||||||
16 | (Source: P.A. 95-478, eff. 8-27-07.)
| ||||||
17 | Section 15. The Workers' Compensation Act is amended by | ||||||
18 | changing Sections 1, 4, 8, 8.2, 8.7, 11, 13, 13.1, 14, 18, 19, | ||||||
19 | and 25.5 and by adding Sections 1.1, 4b, 8.1a, 8.1b, 8.2a, 16b, | ||||||
20 | 18.1, 29.1, and 29.2 as follows:
| ||||||
21 | (820 ILCS 305/1) (from Ch. 48, par. 138.1)
| ||||||
22 | Sec. 1. This Act may be cited as the Workers' Compensation | ||||||
23 | Act.
| ||||||
24 | (a) The term "employer" as used in this Act means:
|
| |||||||
| |||||||
1 | 1. The State and each county, city, town, township, | ||||||
2 | incorporated
village, school district, body politic, or | ||||||
3 | municipal corporation
therein.
| ||||||
4 | 2. Every person, firm, public or private corporation, | ||||||
5 | including
hospitals, public service, eleemosynary, religious | ||||||
6 | or charitable
corporations or associations who has any person | ||||||
7 | in service or under any
contract for hire, express or implied, | ||||||
8 | oral or written, and who is
engaged in any of the enterprises | ||||||
9 | or businesses enumerated in Section 3
of this Act, or who at or | ||||||
10 | prior to the time of the accident to the
employee for which | ||||||
11 | compensation under this Act may be claimed, has in
the manner | ||||||
12 | provided in this Act elected to become subject to the
| ||||||
13 | provisions of this Act, and who has not, prior to such | ||||||
14 | accident,
effected a withdrawal of such election in the manner | ||||||
15 | provided in this Act.
| ||||||
16 | 3. Any one engaging in any business or enterprise referred | ||||||
17 | to in
subsections 1 and 2 of Section 3 of this Act who | ||||||
18 | undertakes to do any
work enumerated therein, is liable to pay | ||||||
19 | compensation to his own
immediate employees in accordance with | ||||||
20 | the provisions of this Act, and
in addition thereto if he | ||||||
21 | directly or indirectly engages any contractor
whether | ||||||
22 | principal or sub-contractor to do any such work, he is liable | ||||||
23 | to
pay compensation to the employees of any such contractor or
| ||||||
24 | sub-contractor unless such contractor or sub-contractor has | ||||||
25 | insured, in
any company or association authorized under the | ||||||
26 | laws of this State to
insure the liability to pay compensation |
| |||||||
| |||||||
1 | under this Act, or guaranteed
his liability to pay such | ||||||
2 | compensation. With respect to any time
limitation on the filing | ||||||
3 | of claims provided by this Act, the timely
filing of a claim | ||||||
4 | against a contractor or subcontractor, as the case may
be, | ||||||
5 | shall be deemed to be a timely filing with respect to all | ||||||
6 | persons
upon whom liability is imposed by this paragraph.
| ||||||
7 | In the event any such person pays compensation under this | ||||||
8 | subsection
he may recover the amount thereof from the | ||||||
9 | contractor or sub-contractor,
if any, and in the event the | ||||||
10 | contractor pays compensation under this
subsection he may | ||||||
11 | recover the amount thereof from the sub-contractor, if any.
| ||||||
12 | This subsection does not apply in any case where the | ||||||
13 | accident occurs
elsewhere than on, in or about the immediate | ||||||
14 | premises on which the
principal has contracted that the work be | ||||||
15 | done.
| ||||||
16 | 4. Where an employer operating under and subject to the | ||||||
17 | provisions
of this Act loans an employee to another such | ||||||
18 | employer and such loaned
employee sustains a compensable | ||||||
19 | accidental injury in the employment of
such borrowing employer | ||||||
20 | and where such borrowing employer does not
provide or pay the | ||||||
21 | benefits or payments due such injured employee, such
loaning | ||||||
22 | employer is liable to provide or pay all benefits or payments
| ||||||
23 | due such employee under this Act and as to such employee the | ||||||
24 | liability
of such loaning and borrowing employers is joint and | ||||||
25 | several, provided
that such loaning employer is in the absence | ||||||
26 | of agreement to the
contrary entitled to receive from such |
| |||||||
| |||||||
1 | borrowing employer full
reimbursement for all sums paid or | ||||||
2 | incurred pursuant to this paragraph
together with reasonable | ||||||
3 | attorneys' fees and expenses in any hearings
before the | ||||||
4 | Illinois Workers' Compensation Commission or in any action to | ||||||
5 | secure such
reimbursement. Where any benefit is provided or | ||||||
6 | paid by such loaning
employer the employee has the duty of | ||||||
7 | rendering reasonable cooperation
in any hearings, trials or | ||||||
8 | proceedings in the case, including such
proceedings for | ||||||
9 | reimbursement.
| ||||||
10 | Where an employee files an Application for Adjustment of | ||||||
11 | Claim with
the Illinois Workers' Compensation
Commission | ||||||
12 | alleging that his claim is covered by the
provisions of the | ||||||
13 | preceding paragraph, and joining both the alleged
loaning and | ||||||
14 | borrowing employers, they and each of them, upon written
demand | ||||||
15 | by the employee and within 7 days after receipt of such demand,
| ||||||
16 | shall have the duty of filing with the Illinois Workers' | ||||||
17 | Compensation Commission a written
admission or denial of the | ||||||
18 | allegation that the claim is covered by the
provisions of the | ||||||
19 | preceding paragraph and in default of such filing or
if any | ||||||
20 | such denial be ultimately determined not to have been bona fide
| ||||||
21 | then the provisions of Paragraph K of Section 19 of this Act | ||||||
22 | shall apply.
| ||||||
23 | An employer whose business or enterprise or a substantial | ||||||
24 | part
thereof consists of hiring, procuring or furnishing | ||||||
25 | employees to or for
other employers operating under and subject | ||||||
26 | to the provisions of this
Act for the performance of the work |
| |||||||
| |||||||
1 | of such other employers and who pays
such employees their | ||||||
2 | salary or wages notwithstanding that they are doing
the work of | ||||||
3 | such other employers shall be deemed a loaning employer
within | ||||||
4 | the meaning and provisions of this Section.
| ||||||
5 | (b) The term "employee" as used in this Act means:
| ||||||
6 | 1. Every person in the service of the State, including | ||||||
7 | members of
the General Assembly, members of the Commerce | ||||||
8 | Commission, members of the
Illinois Workers' Compensation | ||||||
9 | Commission, and all persons in the service of the University
of | ||||||
10 | Illinois, county, including deputy sheriffs and assistant | ||||||
11 | state's
attorneys, city, town, township, incorporated village | ||||||
12 | or school
district, body politic, or municipal corporation | ||||||
13 | therein, whether by
election, under appointment or contract of | ||||||
14 | hire, express or implied,
oral or written, including all | ||||||
15 | members of the Illinois National Guard
while on active duty in | ||||||
16 | the service of the State, and all probation
personnel of the | ||||||
17 | Juvenile Court appointed pursuant to Article VI
of the Juvenile | ||||||
18 | Court Act of 1987, and including any official of the
State, any | ||||||
19 | county, city, town, township, incorporated village, school
| ||||||
20 | district, body politic or municipal corporation therein except | ||||||
21 | any duly
appointed member of a police department in any city | ||||||
22 | whose
population exceeds 200,000 according to the last Federal | ||||||
23 | or State
census, and except any member of a fire insurance | ||||||
24 | patrol maintained by a
board of underwriters in this State. A | ||||||
25 | duly appointed member of a fire
department in any city, the | ||||||
26 | population of which exceeds 200,000 according
to the last |
| |||||||
| |||||||
1 | federal or State census, is an employee under this Act only
| ||||||
2 | with respect to claims brought under paragraph (c) of Section | ||||||
3 | 8.
| ||||||
4 | One employed by a contractor who has contracted with the | ||||||
5 | State, or a
county, city, town, township, incorporated village, | ||||||
6 | school district,
body politic or municipal corporation | ||||||
7 | therein, through its
representatives, is not considered as an | ||||||
8 | employee of the State, county,
city, town, township, | ||||||
9 | incorporated village, school district, body
politic or | ||||||
10 | municipal corporation which made the contract.
| ||||||
11 | 2. Every person in the service of another under any | ||||||
12 | contract of
hire, express or implied, oral or written, | ||||||
13 | including persons whose
employment is outside of the State of | ||||||
14 | Illinois where the contract of
hire is made within the State of | ||||||
15 | Illinois, persons whose employment
results in fatal or | ||||||
16 | non-fatal injuries within the State of Illinois
where the | ||||||
17 | contract of hire is made outside of the State of Illinois, and
| ||||||
18 | persons whose employment is principally localized within the | ||||||
19 | State of
Illinois, regardless of the place of the accident or | ||||||
20 | the place where the
contract of hire was made, and including | ||||||
21 | aliens, and minors who, for the
purpose of this Act are | ||||||
22 | considered the same and have the same power to
contract, | ||||||
23 | receive payments and give quittances therefor, as adult | ||||||
24 | employees.
| ||||||
25 | 3. Every sole proprietor and every partner of a business | ||||||
26 | may elect to
be covered by this Act.
|
| |||||||
| |||||||
1 | An employee or his dependents under this Act who shall have | ||||||
2 | a cause
of action by reason of any injury, disablement or death | ||||||
3 | arising out of
and in the course of his employment may elect to | ||||||
4 | pursue his remedy in
the State where injured or disabled, or in | ||||||
5 | the State where the contract
of hire is made, or in the State | ||||||
6 | where the employment is principally
localized.
| ||||||
7 | However, any employer may elect to provide and pay | ||||||
8 | compensation to
any employee other than those engaged in the | ||||||
9 | usual course of the trade,
business, profession or occupation | ||||||
10 | of the employer by complying with
Sections 2 and 4 of this Act. | ||||||
11 | Employees are not included within the
provisions of this Act | ||||||
12 | when excluded by the laws of the United States
relating to | ||||||
13 | liability of employers to their employees for personal
injuries | ||||||
14 | where such laws are held to be exclusive.
| ||||||
15 | The term "employee" does not include persons performing | ||||||
16 | services as real
estate broker, broker-salesman, or salesman | ||||||
17 | when such persons are paid by
commission only.
| ||||||
18 | (c) "Commission" means the Industrial Commission created | ||||||
19 | by Section
5 of "The Civil Administrative Code of Illinois", | ||||||
20 | approved March 7,
1917, as amended, or the Illinois Workers' | ||||||
21 | Compensation Commission created by Section 13 of
this Act.
| ||||||
22 | (d) To obtain compensation under this Act, an employee | ||||||
23 | bears the burden of showing, by a preponderance of the | ||||||
24 | evidence, that he or she has sustained accidental injuries | ||||||
25 | arising out of and in the course of the employment. | ||||||
26 | (Source: P.A. 93-721, eff. 1-1-05.)
|
| |||||||
| |||||||
1 | (820 ILCS 305/1.1 new) | ||||||
2 | Sec. 1.1. Standards of conduct. | ||||||
3 | (a) Commissioners and arbitrators shall dispose of all | ||||||
4 | Workers' Compensation matters promptly, officially and fairly, | ||||||
5 | without bias or prejudice. Commissioners and arbitrators shall | ||||||
6 | be faithful to the law and maintain professional competence in | ||||||
7 | it. They shall be unswayed by partisan interests, public | ||||||
8 | clamor, or fear of criticism. Commissioners and arbitrators | ||||||
9 | shall take appropriate action or initiate appropriate | ||||||
10 | disciplinary measures against a Commissioner, arbitrator, | ||||||
11 | lawyer, or others for unprofessional conduct of which the | ||||||
12 | Commissioner or arbitrator may become aware. | ||||||
13 | (b) Except as otherwise provided in this Act, the Canons of | ||||||
14 | the Code of Judicial Conduct as adopted by the Supreme Court of | ||||||
15 | Illinois govern the hearing and non-hearing conduct of members | ||||||
16 | of the Commission and arbitrators under this Act. The | ||||||
17 | Commission may set additional rules and standards, not less | ||||||
18 | stringent than those rules and standards established by the | ||||||
19 | Code of Judicial Conduct, for the conduct of arbitrators. | ||||||
20 | (c) The following provisions of the Code of Judicial | ||||||
21 | Conduct do not apply under this Section: | ||||||
22 | (1) Canon 3(B), relating to administrative | ||||||
23 | responsibilities of Judges. | ||||||
24 | (2) Canon 6(C), relating to annual filings of economic | ||||||
25 | interests. Instead of filing declarations of economic |
| |||||||
| |||||||
1 | interests with the Clerk of the Illinois Supreme Court | ||||||
2 | under Illinois Supreme Court Rule 68, members of the | ||||||
3 | Commission and arbitrators shall make filings | ||||||
4 | substantially similar to those required by Rule 68 with the | ||||||
5 | Chairman, and such filings shall be made available for | ||||||
6 | examination by the public. | ||||||
7 | (d) An arbitrator or a Commissioner may accept an | ||||||
8 | uncompensated appointment to a governmental committee, | ||||||
9 | commission or other position that is concerned with issues of | ||||||
10 | policy on matters which may come before the arbitrator or | ||||||
11 | Commissioner if such appointment neither affects his or her | ||||||
12 | independent professional judgment nor the conduct of his or her | ||||||
13 | duties. | ||||||
14 | (e) Decisions of an arbitrator or a Commissioner shall be | ||||||
15 | based exclusively on evidence in the record of the proceeding | ||||||
16 | and material that has been officially noticed. Any findings of | ||||||
17 | fact made by the arbitrator based on inquiries, investigations, | ||||||
18 | examinations, or inspections undertaken by the arbitrator | ||||||
19 | shall be entered into the record of the proceeding. | ||||||
20 | (f) Nothing in this Section shall prohibit an arbitrator | ||||||
21 | from holding a pre-trial conference in accordance with the | ||||||
22 | rules of the Commission.
| ||||||
23 | (820 ILCS 305/4) (from Ch. 48, par. 138.4)
| ||||||
24 | Sec. 4. (a) Any employer, including but not limited to | ||||||
25 | general contractors
and their subcontractors, who shall come |
| |||||||
| |||||||
1 | within the provisions of
Section 3 of this Act, and any other | ||||||
2 | employer who shall elect to provide
and pay the compensation | ||||||
3 | provided for in this Act shall:
| ||||||
4 | (1) File with the Commission annually an application | ||||||
5 | for approval as a
self-insurer which shall include a | ||||||
6 | current financial statement, and
annually, thereafter, an | ||||||
7 | application for renewal of self-insurance, which
shall | ||||||
8 | include a current financial statement. Said
application | ||||||
9 | and financial statement shall be signed and sworn to by the
| ||||||
10 | president or vice president and secretary or assistant | ||||||
11 | secretary of the
employer if it be a corporation, or by all | ||||||
12 | of the partners, if it be a
copartnership, or by the owner | ||||||
13 | if it be neither a copartnership nor a
corporation. All | ||||||
14 | initial applications and all applications for renewal of
| ||||||
15 | self-insurance must be submitted at least 60 days prior to | ||||||
16 | the requested
effective date of self-insurance. An | ||||||
17 | employer may elect to provide and pay
compensation as | ||||||
18 | provided
for in this Act as a member of a group workers' | ||||||
19 | compensation pool under Article
V 3/4 of the Illinois | ||||||
20 | Insurance Code. If an employer becomes a member of a
group | ||||||
21 | workers' compensation pool, the employer shall not be | ||||||
22 | relieved of any
obligations imposed by this Act.
| ||||||
23 | If the sworn application and financial statement of any | ||||||
24 | such employer
does not satisfy the Commission of the | ||||||
25 | financial ability of the employer
who has filed it, the | ||||||
26 | Commission shall require such employer to,
|
| |||||||
| |||||||
1 | (2) Furnish security, indemnity or a bond guaranteeing | ||||||
2 | the payment
by the employer of the compensation provided | ||||||
3 | for in this Act, provided
that any such employer whose | ||||||
4 | application and financial statement shall
not have | ||||||
5 | satisfied the commission of his or her financial ability | ||||||
6 | and
who shall have secured his liability in part by excess | ||||||
7 | liability insurance
shall be required to furnish to the | ||||||
8 | Commission security, indemnity or bond
guaranteeing his or | ||||||
9 | her payment up to the effective limits of the excess
| ||||||
10 | coverage, or
| ||||||
11 | (3) Insure his entire liability to pay such | ||||||
12 | compensation in some
insurance carrier authorized, | ||||||
13 | licensed, or permitted to do such
insurance business in | ||||||
14 | this State. Every policy of an insurance carrier,
insuring | ||||||
15 | the payment of compensation under this Act shall cover all | ||||||
16 | the
employees and the entire compensation liability of the | ||||||
17 | insured:
Provided, however, that any employer may insure | ||||||
18 | his or her compensation
liability with 2 or more insurance | ||||||
19 | carriers or may insure a part and
qualify under subsection | ||||||
20 | 1, 2, or 4 for the remainder of his or her
liability to pay | ||||||
21 | such compensation, subject to the following two | ||||||
22 | provisions:
| ||||||
23 | Firstly, the entire compensation liability of the | ||||||
24 | employer to
employees working at or from one location | ||||||
25 | shall be insured in one such
insurance carrier or shall | ||||||
26 | be self-insured, and
|
| |||||||
| |||||||
1 | Secondly, the employer shall submit evidence | ||||||
2 | satisfactorily to the
Commission that his or her entire | ||||||
3 | liability for the compensation provided
for in this Act | ||||||
4 | will be secured. Any provisions in any policy, or in | ||||||
5 | any
endorsement attached thereto, attempting to limit | ||||||
6 | or modify in any way,
the liability of the insurance | ||||||
7 | carriers issuing the same except as
otherwise provided | ||||||
8 | herein shall be wholly void.
| ||||||
9 | Nothing herein contained shall apply to policies of | ||||||
10 | excess liability
carriage secured by employers who have | ||||||
11 | been approved by the Commission
as self-insurers, or
| ||||||
12 | (4) Make some other provision, satisfactory to the | ||||||
13 | Commission, for
the securing of the payment of compensation | ||||||
14 | provided for in this Act,
and
| ||||||
15 | (5) Upon becoming subject to this Act and thereafter as | ||||||
16 | often as the
Commission may in writing demand, file with | ||||||
17 | the Commission in form prescribed
by it evidence of his or | ||||||
18 | her compliance with the provision of this Section.
| ||||||
19 | (a-1) Regardless of its state of domicile or its principal | ||||||
20 | place of
business, an employer shall make payments to its | ||||||
21 | insurance carrier or group
self-insurance fund, where | ||||||
22 | applicable, based upon the premium rates of the
situs where the | ||||||
23 | work or project is located in Illinois if:
| ||||||
24 | (A) the employer is engaged primarily in the building | ||||||
25 | and
construction industry; and
| ||||||
26 | (B) subdivision (a)(3) of this Section applies to the |
| |||||||
| |||||||
1 | employer or
the employer is a member of a group | ||||||
2 | self-insurance plan as defined in
subsection (1) of Section | ||||||
3 | 4a.
| ||||||
4 | The Illinois Workers' Compensation Commission shall impose | ||||||
5 | a penalty upon an employer
for violation of this subsection | ||||||
6 | (a-1) if:
| ||||||
7 | (i) the employer is given an opportunity at a hearing | ||||||
8 | to present
evidence of its compliance with this subsection | ||||||
9 | (a-1); and
| ||||||
10 | (ii) after the hearing, the Commission finds that the | ||||||
11 | employer
failed to make payments upon the premium rates of | ||||||
12 | the situs where the work or
project is located in Illinois.
| ||||||
13 | The penalty shall not exceed $1,000 for each day of work | ||||||
14 | for which
the employer failed to make payments upon the premium | ||||||
15 | rates of the situs where
the
work or project is located in | ||||||
16 | Illinois, but the total penalty shall not exceed
$50,000 for | ||||||
17 | each project or each contract under which the work was
| ||||||
18 | performed.
| ||||||
19 | Any penalty under this subsection (a-1) must be imposed not | ||||||
20 | later
than one year after the expiration of the applicable | ||||||
21 | limitation period
specified in subsection (d) of Section 6 of | ||||||
22 | this Act. Penalties imposed under
this subsection (a-1) shall | ||||||
23 | be deposited into the Illinois Workers' Compensation | ||||||
24 | Commission
Operations Fund, a special fund that is created in | ||||||
25 | the State treasury. Subject
to appropriation, moneys in the | ||||||
26 | Fund shall be used solely for the operations
of the Illinois |
| |||||||
| |||||||
1 | Workers' Compensation Commission and by the Department of | ||||||
2 | Insurance Financial and Professional Regulation for the | ||||||
3 | purposes authorized in subsection (c) of Section 25.5 of this | ||||||
4 | Act.
| ||||||
5 | (a-2) Every Employee Leasing Company (ELC), as defined in | ||||||
6 | Section 15 of the Employee Leasing Company Act, shall at a | ||||||
7 | minimum provide the following information to the Commission or | ||||||
8 | any entity designated by the Commission regarding each workers' | ||||||
9 | compensation insurance policy issued to the ELC: | ||||||
10 | (1) Any client company of the ELC listed as an | ||||||
11 | additional named insured. | ||||||
12 | (2) Any informational schedule attached to the master | ||||||
13 | policy that identifies any individual client company's | ||||||
14 | name, FEIN, and job location. | ||||||
15 | (3) Any certificate of insurance coverage document | ||||||
16 | issued to a client company specifying its rights and | ||||||
17 | obligations under the master policy that establishes both | ||||||
18 | the identity and status of the client, as well as the dates | ||||||
19 | of inception and termination of coverage, if applicable. | ||||||
20 | (b) The sworn application and financial statement, or | ||||||
21 | security,
indemnity or bond, or amount of insurance, or other | ||||||
22 | provisions, filed,
furnished, carried, or made by the employer, | ||||||
23 | as the case may be, shall
be subject to the approval of the | ||||||
24 | Commission.
| ||||||
25 | Deposits under escrow agreements shall be cash, negotiable | ||||||
26 | United
States government bonds or negotiable general |
| |||||||
| |||||||
1 | obligation bonds of the
State of Illinois. Such cash or bonds | ||||||
2 | shall be deposited in
escrow with any State or National Bank or | ||||||
3 | Trust Company having trust
authority in the State of Illinois.
| ||||||
4 | Upon the approval of the sworn application and financial | ||||||
5 | statement,
security, indemnity or bond or amount of insurance, | ||||||
6 | filed, furnished or
carried, as the case may be, the Commission | ||||||
7 | shall send to the employer
written notice of its approval | ||||||
8 | thereof. The certificate of compliance
by the employer with the | ||||||
9 | provisions of subparagraphs (2) and (3) of
paragraph (a) of | ||||||
10 | this Section shall be delivered by the insurance
carrier to the | ||||||
11 | Illinois Workers' Compensation Commission within five days | ||||||
12 | after the
effective date of the policy so certified. The | ||||||
13 | insurance so certified
shall cover all compensation liability | ||||||
14 | occurring during the time that
the insurance is in effect and | ||||||
15 | no further certificate need be filed in case
such insurance is | ||||||
16 | renewed, extended or otherwise continued by such
carrier. The | ||||||
17 | insurance so certified shall not be cancelled or in the
event | ||||||
18 | that such insurance is not renewed, extended or otherwise
| ||||||
19 | continued, such insurance shall not be terminated until at | ||||||
20 | least 10
days after receipt by the Illinois Workers' | ||||||
21 | Compensation Commission of notice of the
cancellation or | ||||||
22 | termination of said insurance; provided, however, that
if the | ||||||
23 | employer has secured insurance from another insurance carrier, | ||||||
24 | or
has otherwise secured the payment of compensation in | ||||||
25 | accordance with
this Section, and such insurance or other | ||||||
26 | security becomes effective
prior to the expiration of the 10 |
| |||||||
| |||||||
1 | days, cancellation or termination may, at
the option of the | ||||||
2 | insurance carrier indicated in such notice, be effective
as of | ||||||
3 | the effective date of such other insurance or security.
| ||||||
4 | (c) Whenever the Commission shall find that any | ||||||
5 | corporation,
company, association, aggregation of individuals, | ||||||
6 | reciprocal or
interinsurers exchange, or other insurer | ||||||
7 | effecting workers' compensation
insurance in this State shall | ||||||
8 | be insolvent, financially unsound, or
unable to fully meet all | ||||||
9 | payments and liabilities assumed or to be
assumed for | ||||||
10 | compensation insurance in this State, or shall practice a
| ||||||
11 | policy of delay or unfairness toward employees in the | ||||||
12 | adjustment,
settlement, or payment of benefits due such | ||||||
13 | employees, the Commission
may after reasonable notice and | ||||||
14 | hearing order and direct that such
corporation, company, | ||||||
15 | association, aggregation of individuals,
reciprocal or | ||||||
16 | interinsurers exchange, or insurer, shall from and after a
date | ||||||
17 | fixed in such order discontinue the writing of any such | ||||||
18 | workers'
compensation insurance in this State. Subject to such | ||||||
19 | modification of
the order as the Commission may later make on | ||||||
20 | review of the order,
as herein provided, it shall thereupon be | ||||||
21 | unlawful for any such
corporation, company, association, | ||||||
22 | aggregation of individuals,
reciprocal or interinsurers | ||||||
23 | exchange, or insurer to effect any workers'
compensation | ||||||
24 | insurance in this State. A copy of the order shall be served
| ||||||
25 | upon the Director of Insurance by registered mail. Whenever the | ||||||
26 | Commission
finds that any service or adjustment company used or |
| |||||||
| |||||||
1 | employed
by a self-insured employer or by an insurance carrier | ||||||
2 | to process,
adjust, investigate, compromise or otherwise | ||||||
3 | handle claims under this
Act, has practiced or is practicing a | ||||||
4 | policy of delay or unfairness
toward employees in the | ||||||
5 | adjustment, settlement or payment of benefits
due such | ||||||
6 | employees, the Commission may after reasonable notice and
| ||||||
7 | hearing order and direct that such service or adjustment | ||||||
8 | company shall
from and after a date fixed in such order be | ||||||
9 | prohibited from processing,
adjusting, investigating, | ||||||
10 | compromising or otherwise handling claims
under this Act.
| ||||||
11 | Whenever the Commission finds that any self-insured | ||||||
12 | employer has
practiced or is practicing delay or unfairness | ||||||
13 | toward employees in the
adjustment, settlement or payment of | ||||||
14 | benefits due such employees, the
Commission may, after | ||||||
15 | reasonable notice and hearing, order and direct
that after a | ||||||
16 | date fixed in the order such self-insured employer shall be
| ||||||
17 | disqualified to operate as a self-insurer and shall be required | ||||||
18 | to
insure his entire liability to pay compensation in some | ||||||
19 | insurance
carrier authorized, licensed and permitted to do such | ||||||
20 | insurance business
in this State, as provided in subparagraph 3 | ||||||
21 | of paragraph (a) of this
Section.
| ||||||
22 | All orders made by the Commission under this Section shall | ||||||
23 | be subject
to review by the courts, said review to be taken in | ||||||
24 | the same manner and
within the same time as provided by Section | ||||||
25 | 19 of this Act for review of
awards and decisions of the | ||||||
26 | Commission, upon the party seeking the
review filing with the |
| |||||||
| |||||||
1 | clerk of the court to which said review is taken
a bond in an | ||||||
2 | amount to be fixed and approved by the court to which the
| ||||||
3 | review is taken, conditioned upon the payment of all | ||||||
4 | compensation awarded
against the person taking said review | ||||||
5 | pending a decision thereof and
further conditioned upon such | ||||||
6 | other obligations as the court may impose.
Upon the review the | ||||||
7 | Circuit Court shall have power to review all questions
of fact | ||||||
8 | as well as of law. The penalty hereinafter provided for in this
| ||||||
9 | paragraph shall not attach and shall not begin to run until the | ||||||
10 | final
determination of the order of the Commission.
| ||||||
11 | (d) Whenever a panel of 3 Commissioners comprised of one | ||||||
12 | member of the employing class, one member of the employee | ||||||
13 | class, and one member not identified with either the employing | ||||||
14 | or employee class, with due process and after a hearing, | ||||||
15 | determines an employer has knowingly failed to provide coverage | ||||||
16 | as required by paragraph (a) of this Section, the failure shall | ||||||
17 | be deemed an immediate serious danger to public health, safety, | ||||||
18 | and welfare sufficient to justify service by the Commission of | ||||||
19 | a work-stop order on such employer, requiring the cessation of | ||||||
20 | all business operations of such employer at the place of | ||||||
21 | employment or job site. Any law enforcement agency in the State | ||||||
22 | shall, at the request of the Commission, render any assistance | ||||||
23 | necessary to carry out the provisions of this Section, | ||||||
24 | including, but not limited to, preventing any employee of such | ||||||
25 | employer from remaining at a place of employment or job site | ||||||
26 | after a work-stop order has taken effect. Any work-stop order |
| |||||||
| |||||||
1 | shall be lifted upon proof of insurance as required by this | ||||||
2 | Act. Any orders under this Section are appealable under Section | ||||||
3 | 19(f) to the Circuit Court.
| ||||||
4 | Any individual employer, corporate officer or director of a | ||||||
5 | corporate employer, partner of an employer partnership, or | ||||||
6 | member of an employer limited liability company who knowingly | ||||||
7 | fails to provide coverage as required by paragraph (a) of this | ||||||
8 | Section is guilty of a Class 4 felony. This provision shall not | ||||||
9 | apply to any corporate officer or director of any | ||||||
10 | publicly-owned corporation. Each day's violation constitutes a | ||||||
11 | separate offense. The State's Attorney of the county in which | ||||||
12 | the violation occurred, or the Attorney General, shall bring | ||||||
13 | such actions in the name of the People of the State of | ||||||
14 | Illinois, or may, in addition to other remedies provided in | ||||||
15 | this Section, bring an action for an injunction to restrain the | ||||||
16 | violation or to enjoin the operation of any such employer.
| ||||||
17 | Any individual employer, corporate officer or director of a | ||||||
18 | corporate employer, partner of an employer partnership, or | ||||||
19 | member of an employer limited liability company who negligently | ||||||
20 | fails to provide coverage as required by paragraph (a) of this | ||||||
21 | Section is guilty of a Class A misdemeanor. This provision | ||||||
22 | shall not apply to any corporate officer or director of any | ||||||
23 | publicly-owned corporation. Each day's violation constitutes a | ||||||
24 | separate offense. The State's Attorney of the county in which | ||||||
25 | the violation occurred, or the Attorney General, shall bring | ||||||
26 | such actions in the name of the People of the State of |
| |||||||
| |||||||
1 | Illinois.
| ||||||
2 | The criminal penalties in this subsection (d) shall not | ||||||
3 | apply where
there exists a good faith dispute as to the | ||||||
4 | existence of an
employment relationship. Evidence of good faith | ||||||
5 | shall
include, but not be limited to, compliance with the | ||||||
6 | definition
of employee as used by the Internal Revenue Service.
| ||||||
7 | Employers who are subject to and who knowingly fail to | ||||||
8 | comply with this Section shall not be entitled to the benefits | ||||||
9 | of this Act during the period of noncompliance, but shall be | ||||||
10 | liable in an action under any other applicable law of this | ||||||
11 | State. In the action, such employer shall not avail himself or | ||||||
12 | herself of the defenses of assumption of risk or negligence or | ||||||
13 | that the injury was due to a co-employee. In the action, proof | ||||||
14 | of the injury shall constitute prima facie evidence of | ||||||
15 | negligence on the part of such employer and the burden shall be | ||||||
16 | on such employer to show freedom of negligence resulting in the | ||||||
17 | injury. The employer shall not join any other defendant in any | ||||||
18 | such civil action. Nothing in this amendatory Act of the 94th | ||||||
19 | General Assembly shall affect the employee's rights under | ||||||
20 | subdivision (a)3 of Section 1 of this Act. Any employer or | ||||||
21 | carrier who makes payments under subdivision (a)3 of Section 1 | ||||||
22 | of this Act shall have a right of reimbursement from the | ||||||
23 | proceeds of any recovery under this Section.
| ||||||
24 | An employee of an uninsured employer, or the employee's | ||||||
25 | dependents in case death ensued, may, instead of proceeding | ||||||
26 | against the employer in a civil action in court, file an |
| |||||||
| |||||||
1 | application for adjustment of claim with the Commission in | ||||||
2 | accordance with the provisions of this Act and the Commission | ||||||
3 | shall hear and determine the application for adjustment of | ||||||
4 | claim in the manner in which other claims are heard and | ||||||
5 | determined before the Commission.
| ||||||
6 | All proceedings under this subsection (d) shall be reported | ||||||
7 | on an annual basis to the Workers' Compensation Advisory Board.
| ||||||
8 | An investigator with the Illinois Workers' Compensation | ||||||
9 | Commission Insurance Compliance Division may issue a citation | ||||||
10 | to any employer that is not in compliance with its obligation | ||||||
11 | to have workers' compensation insurance under this Act. The | ||||||
12 | amount of the fine shall be based on the period of time the | ||||||
13 | employer was in non-compliance, but shall be no less than $500, | ||||||
14 | and shall not exceed $2,500. An employer that has been issued a | ||||||
15 | citation shall pay the fine to the Commission and provide to | ||||||
16 | the Commission proof that it obtained the required workers' | ||||||
17 | compensation insurance within 10 days after the citation was | ||||||
18 | issued. This Section does not affect any other obligations this | ||||||
19 | Act imposes on employers. | ||||||
20 | Upon a finding by the Commission, after reasonable notice | ||||||
21 | and
hearing, of the knowing and wilful failure or refusal of an | ||||||
22 | employer to
comply with
any of the provisions of paragraph (a) | ||||||
23 | of this Section , or the failure or
refusal of an employer, | ||||||
24 | service or adjustment company, or an insurance
carrier to | ||||||
25 | comply with any order of the Illinois Workers' Compensation | ||||||
26 | Commission pursuant to
paragraph (c) of this Section |
| |||||||
| |||||||
1 | disqualifying him or her to operate as a self
insurer and | ||||||
2 | requiring him or her to insure his or her liability, or the | ||||||
3 | knowing and willful failure of an employer to comply with a | ||||||
4 | citation issued by an investigator with the Illinois Workers' | ||||||
5 | Compensation Commission Insurance Compliance Division, the
| ||||||
6 | Commission may assess a civil penalty of up to $500 per day for | ||||||
7 | each day of
such failure or refusal after the effective date of | ||||||
8 | this amendatory Act of
1989. The minimum penalty under this | ||||||
9 | Section shall be the sum of $10,000.
Each day of such failure | ||||||
10 | or refusal shall constitute a separate offense.
The Commission | ||||||
11 | may assess the civil penalty personally and individually
| ||||||
12 | against the corporate officers and directors of a corporate | ||||||
13 | employer, the
partners of an employer partnership, and the | ||||||
14 | members of an employer limited
liability company, after a | ||||||
15 | finding of a knowing and willful refusal or failure
of each | ||||||
16 | such named corporate officer, director, partner, or member to | ||||||
17 | comply
with this Section. The liability for the assessed | ||||||
18 | penalty shall be
against the named employer first, and
if the | ||||||
19 | named employer fails or refuses to pay the penalty to the
| ||||||
20 | Commission within 30 days after the final order of the | ||||||
21 | Commission, then the
named
corporate officers, directors, | ||||||
22 | partners, or members who have been found to have
knowingly and | ||||||
23 | willfully refused or failed to comply with this Section shall | ||||||
24 | be
liable for the unpaid penalty or any unpaid portion of the | ||||||
25 | penalty. Upon investigation by the insurance non-compliance | ||||||
26 | unit of the Commission, the Attorney General shall have the |
| |||||||
| |||||||
1 | authority to prosecute all proceedings to enforce the civil and | ||||||
2 | administrative provisions of this Section before the | ||||||
3 | Commission. The Commission shall promulgate procedural rules | ||||||
4 | for enforcing this Section.
| ||||||
5 | Upon the failure or refusal of any employer, service or | ||||||
6 | adjustment
company or insurance carrier to comply with the | ||||||
7 | provisions of this Section
and with the orders of the | ||||||
8 | Commission under this Section, or the order of
the court on | ||||||
9 | review after final adjudication, the Commission may bring a
| ||||||
10 | civil action to recover the amount of the penalty in Cook | ||||||
11 | County or in
Sangamon County in which litigation the Commission | ||||||
12 | shall be represented by
the Attorney General. The Commission | ||||||
13 | shall send notice of its finding of
non-compliance and | ||||||
14 | assessment of the civil penalty to the Attorney General.
It | ||||||
15 | shall be the duty of the Attorney General within 30 days after | ||||||
16 | receipt
of the notice, to institute prosecutions and promptly | ||||||
17 | prosecute all
reported violations of this Section.
| ||||||
18 | Any individual employer, corporate officer or director of a | ||||||
19 | corporate employer, partner of an employer partnership, or | ||||||
20 | member of an employer limited liability company who, with the | ||||||
21 | intent to avoid payment of compensation under this Act to an | ||||||
22 | injured employee or the employee's dependents, knowingly | ||||||
23 | transfers, sells, encumbers, assigns, or in any manner disposes | ||||||
24 | of, conceals, secretes, or destroys any property belonging to | ||||||
25 | the employer, officer, director, partner, or member is guilty | ||||||
26 | of a Class 4 felony.
|
| |||||||
| |||||||
1 | Penalties and fines collected pursuant to this paragraph | ||||||
2 | (d) shall be deposited upon receipt into a special fund which | ||||||
3 | shall be designated the Injured Workers' Benefit Fund, of which | ||||||
4 | the State Treasurer is ex-officio custodian, such special fund | ||||||
5 | to be held and disbursed in accordance with this paragraph (d) | ||||||
6 | for the purposes hereinafter stated in this paragraph (d), upon | ||||||
7 | the final order of the Commission. The Injured Workers' Benefit | ||||||
8 | Fund shall be deposited the same as are State funds and any | ||||||
9 | interest accruing thereon shall be added thereto every 6 | ||||||
10 | months. The Injured Workers' Benefit Fund is subject to audit | ||||||
11 | the same as State funds and accounts and is protected by the | ||||||
12 | general bond given by the State Treasurer. The Injured Workers' | ||||||
13 | Benefit Fund is considered always appropriated for the purposes | ||||||
14 | of disbursements as provided in this paragraph, and shall be | ||||||
15 | paid out and disbursed as herein provided and shall not at any | ||||||
16 | time be appropriated or diverted to any other use or purpose. | ||||||
17 | Moneys in the Injured Workers' Benefit Fund shall be used only | ||||||
18 | for payment of workers' compensation benefits for injured | ||||||
19 | employees when the employer has failed to provide coverage as | ||||||
20 | determined under this paragraph (d) and has failed to pay the | ||||||
21 | benefits due to the injured employee. The Commission shall have | ||||||
22 | the right to obtain reimbursement from the employer for | ||||||
23 | compensation obligations paid by the Injured Workers' Benefit | ||||||
24 | Fund. Any such amounts obtained shall be deposited by the | ||||||
25 | Commission into the Injured Workers' Benefit Fund. If an | ||||||
26 | injured employee or his or her personal representative receives |
| |||||||
| |||||||
1 | payment from the Injured Workers' Benefit Fund, the State of | ||||||
2 | Illinois has the same rights under paragraph (b) of Section 5 | ||||||
3 | that the employer who failed to pay the benefits due to the | ||||||
4 | injured employee would have had if the employer had paid those | ||||||
5 | benefits, and any moneys recovered by the State as a result of | ||||||
6 | the State's exercise of its rights under paragraph (b) of | ||||||
7 | Section 5 shall be deposited into the Injured Workers' Benefit | ||||||
8 | Fund. The custodian of the Injured Workers' Benefit Fund shall | ||||||
9 | be joined with the employer as a party respondent in the | ||||||
10 | application for adjustment of claim. After July 1, 2006, the | ||||||
11 | Commission shall make disbursements from the Fund once each | ||||||
12 | year to each eligible claimant. An eligible claimant is an | ||||||
13 | injured worker who has within the previous fiscal year obtained | ||||||
14 | a final award for benefits from the Commission against the | ||||||
15 | employer and the Injured Workers' Benefit Fund and has notified | ||||||
16 | the Commission within 90 days of receipt of such award. Within | ||||||
17 | a reasonable time after the end of each fiscal year, the | ||||||
18 | Commission shall make a disbursement to each eligible claimant. | ||||||
19 | At the time of disbursement, if there are insufficient moneys | ||||||
20 | in the Fund to pay all claims, each eligible claimant shall | ||||||
21 | receive a pro-rata share, as determined by the Commission, of | ||||||
22 | the available moneys in the Fund for that year. Payment from | ||||||
23 | the Injured Workers' Benefit Fund to an eligible claimant | ||||||
24 | pursuant to this provision shall discharge the obligations of | ||||||
25 | the Injured Workers' Benefit Fund regarding the award entered | ||||||
26 | by the Commission.
|
| |||||||
| |||||||
1 | (e) This Act shall not affect or disturb the continuance of | ||||||
2 | any
existing insurance, mutual aid, benefit, or relief | ||||||
3 | association or
department, whether maintained in whole or in | ||||||
4 | part by the employer or
whether maintained by the employees, | ||||||
5 | the payment of benefits of such
association or department being | ||||||
6 | guaranteed by the employer or by some
person, firm or | ||||||
7 | corporation for him or her: Provided, the employer contributes
| ||||||
8 | to such association or department an amount not less than the | ||||||
9 | full
compensation herein provided, exclusive of the cost of the | ||||||
10 | maintenance
of such association or department and without any | ||||||
11 | expense to the
employee. This Act shall not prevent the | ||||||
12 | organization and maintaining
under the insurance laws of this | ||||||
13 | State of any benefit or insurance
company for the purpose of | ||||||
14 | insuring against the compensation provided
for in this Act, the | ||||||
15 | expense of which is maintained by the employer.
This Act shall | ||||||
16 | not prevent the organization or maintaining under the
insurance | ||||||
17 | laws of this State of any voluntary mutual aid, benefit or
| ||||||
18 | relief association among employees for the payment of | ||||||
19 | additional
accident or sick benefits.
| ||||||
20 | (f) No existing insurance, mutual aid, benefit or relief | ||||||
21 | association
or department shall, by reason of anything herein | ||||||
22 | contained, be
authorized to discontinue its operation without | ||||||
23 | first discharging its
obligations to any and all persons | ||||||
24 | carrying insurance in the same or
entitled to relief or | ||||||
25 | benefits therein.
| ||||||
26 | (g) Any contract, oral, written or implied, of employment |
| |||||||
| |||||||
1 | providing
for relief benefit, or insurance or any other device | ||||||
2 | whereby the
employee is required to pay any premium or premiums | ||||||
3 | for insurance
against the compensation provided for in this Act | ||||||
4 | shall be null and
void. Any employer withholding from the wages | ||||||
5 | of any employee any
amount for the purpose of paying any such | ||||||
6 | premium shall be guilty of a
Class B misdemeanor.
| ||||||
7 | In the event the employer does not pay the compensation for | ||||||
8 | which he or
she is liable, then an insurance company, | ||||||
9 | association or insurer which may
have insured such employer | ||||||
10 | against such liability shall become primarily
liable to pay to | ||||||
11 | the employee, his or her personal representative or
beneficiary | ||||||
12 | the compensation required by the provisions of this Act to
be | ||||||
13 | paid by such employer. The insurance carrier may be made a | ||||||
14 | party to
the proceedings in which the employer is a party and | ||||||
15 | an award may be
entered jointly against the employer and the | ||||||
16 | insurance carrier.
| ||||||
17 | (h) It shall be unlawful for any employer, insurance | ||||||
18 | company or
service or adjustment company to interfere with, | ||||||
19 | restrain or coerce an
employee in any manner whatsoever in the | ||||||
20 | exercise of the rights or
remedies granted to him or her by | ||||||
21 | this Act or to discriminate, attempt to
discriminate, or | ||||||
22 | threaten to discriminate against an employee in any way
because | ||||||
23 | of his or her exercise of the rights or remedies granted to
him | ||||||
24 | or her by this Act.
| ||||||
25 | It shall be unlawful for any employer, individually or | ||||||
26 | through any
insurance company or service or adjustment company, |
| |||||||
| |||||||
1 | to discharge or to
threaten to discharge, or to refuse to | ||||||
2 | rehire or recall to active
service in a suitable capacity an | ||||||
3 | employee because of the exercise of
his or her rights or | ||||||
4 | remedies granted to him or her by this Act.
| ||||||
5 | (i) If an employer elects to obtain a life insurance policy | ||||||
6 | on his
employees, he may also elect to apply such benefits in | ||||||
7 | satisfaction of all
or a portion of the death benefits payable | ||||||
8 | under this Act, in which case,
the employer's compensation | ||||||
9 | premium shall be reduced accordingly.
| ||||||
10 | (j) Within 45 days of receipt of an initial application or | ||||||
11 | application
to renew self-insurance privileges the | ||||||
12 | Self-Insurers Advisory Board shall
review and submit for | ||||||
13 | approval by the Chairman of the Commission
recommendations of | ||||||
14 | disposition of all initial applications to self-insure
and all | ||||||
15 | applications to renew self-insurance privileges filed by | ||||||
16 | private
self-insurers pursuant to the provisions of this | ||||||
17 | Section and Section 4a-9
of this Act. Each private self-insurer | ||||||
18 | shall submit with its initial and
renewal applications the | ||||||
19 | application fee required by Section 4a-4 of this Act.
| ||||||
20 | The Chairman of the Commission shall promptly act upon all | ||||||
21 | initial
applications and applications for renewal in full | ||||||
22 | accordance with the
recommendations of the Board or, should the | ||||||
23 | Chairman disagree with any
recommendation of disposition of the | ||||||
24 | Self-Insurer's Advisory Board, he
shall within 30 days of | ||||||
25 | receipt of such recommendation provide to the Board
in writing | ||||||
26 | the reasons supporting his decision. The Chairman shall also
|
| |||||||
| |||||||
1 | promptly notify the employer of his decision within 15 days of | ||||||
2 | receipt of
the recommendation of the Board.
| ||||||
3 | If an employer is denied a renewal of self-insurance | ||||||
4 | privileges pursuant
to application it shall retain said | ||||||
5 | privilege for 120 days after receipt of
a notice of | ||||||
6 | cancellation of the privilege from the Chairman of the | ||||||
7 | Commission.
| ||||||
8 | All orders made by the Chairman under this Section shall be | ||||||
9 | subject to
review by the courts, such review to be taken in the | ||||||
10 | same manner and within
the same time as provided by subsection | ||||||
11 | (f) of Section 19 of this Act for
review of awards and | ||||||
12 | decisions of the Commission, upon the party seeking
the review | ||||||
13 | filing with the clerk of the court to which such review is | ||||||
14 | taken
a bond in an amount to be fixed and approved by the court | ||||||
15 | to which the
review is taken, conditioned upon the payment of | ||||||
16 | all compensation awarded
against the person taking such review | ||||||
17 | pending a decision thereof and
further conditioned upon such | ||||||
18 | other obligations as the court may impose.
Upon the review the | ||||||
19 | Circuit Court shall have power to review all questions
of fact | ||||||
20 | as well as of law.
| ||||||
21 | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; | ||||||
22 | 94-839, eff. 6-6-06.)
| ||||||
23 | (820 ILCS 305/4b new) | ||||||
24 | Sec. 4b. Collective bargaining pilot program. | ||||||
25 | (a) The Director of the Department of Labor shall adopt a |
| |||||||
| |||||||
1 | selection process to designate 2 international, national, or | ||||||
2 | statewide organizations made up of affiliates who are the | ||||||
3 | exclusive representatives of construction employer employees | ||||||
4 | recognized or certified pursuant to the National Labor | ||||||
5 | Relations Act
to
participate in the collective bargaining pilot | ||||||
6 | program provided for in this Section. | ||||||
7 | (a-5) For purposes of this Section, the term "construction | ||||||
8 | employer" means any person or legal entity or group of persons | ||||||
9 | or legal entities engaging in or planning to engage in any | ||||||
10 | constructing, altering, reconstructing, repairing, | ||||||
11 | rehabilitating, refinishing, refurbishing, remodeling, | ||||||
12 | remediating, renovating, custom fabricating, maintaining, | ||||||
13 | landscaping, improving, wrecking, painting, decorating, | ||||||
14 | demolishing, and adding to or subtracting from any building, | ||||||
15 | structure, airport facility, highway, roadway, street, alley, | ||||||
16 | bridge, sewer, drain, ditch, sewage disposal plant, water | ||||||
17 | works, parking facility, railroad, excavation or other | ||||||
18 | project, structure, development, real property or improvement, | ||||||
19 | or to do any part thereof, whether or not the performance of | ||||||
20 | the work herein described involves the addition to, or | ||||||
21 | fabrication into, any project, structure, development, real | ||||||
22 | property or improvement herein described, and shall also | ||||||
23 | include any moving of construction-related materials on the job | ||||||
24 | site or to or from the job site. | ||||||
25 | For purposes of this Section, "labor organization" means an | ||||||
26 | affiliate of an international, national, or statewide |
| |||||||
| |||||||
1 | organization that has been selected by the Department of Labor | ||||||
2 | to participate in the collective bargaining pilot program as | ||||||
3 | provided for in this Section. | ||||||
4 | (b) Upon appropriate filing, the Commission and the courts | ||||||
5 | of this State shall recognize as valid and binding any | ||||||
6 | provision in a collective bargaining agreement between any | ||||||
7 | construction employer or group of construction employers and a | ||||||
8 | labor organization, which contains certain obligations and | ||||||
9 | procedures relating to workers' compensation. This agreement | ||||||
10 | must be limited to, but need not include, all of the following: | ||||||
11 | (1) An alternative dispute resolution ("ADR") system | ||||||
12 | to supplement, modify or replace the procedural or dispute | ||||||
13 | resolution provisions of this Act. The system may include | ||||||
14 | mediation, arbitration, or other dispute resolution | ||||||
15 | proceedings, the results of which shall be final and | ||||||
16 | binding upon the parties; | ||||||
17 | (2) An agreed list of medical treatment providers that | ||||||
18 | may be the exclusive source of all medical and related | ||||||
19 | treatment provided under this Act; | ||||||
20 | (3) The use of a limited list of impartial physicians | ||||||
21 | to conduct independent medical examinations; | ||||||
22 | (4) The creation of a light duty, modified job, or | ||||||
23 | return to work program; | ||||||
24 | (5) The use of a limited list of individuals and | ||||||
25 | companies for the establishment of vocational | ||||||
26 | rehabilitation or retraining programs that may be the |
| |||||||
| |||||||
1 | exclusive source of rehabilitation and retraining services | ||||||
2 | provided under this Act; or | ||||||
3 | (6) The establishment of joint labor management safety | ||||||
4 | committees and safety procedures. | ||||||
5 | (c) Void agreements. Nothing in this Section shall be | ||||||
6 | construed to authorize any provision in a collective bargaining | ||||||
7 | agreement that diminishes or increases a construction | ||||||
8 | employer's entitlements under this Act or an employee's | ||||||
9 | entitlement to benefits as otherwise set forth in this Act. For | ||||||
10 | the purposes of this Section, the procedural rights and dispute | ||||||
11 | resolution agreements under subparagraphs (1) through (6) of | ||||||
12 | subsection (b) of this Section are not agreements which | ||||||
13 | diminish or increase a construction employer's entitlements | ||||||
14 | under this Act or an employee's entitlement to benefits under | ||||||
15 | this Act. Any agreement that diminishes or increases a | ||||||
16 | construction employer's entitlements under this Act or an | ||||||
17 | employee's entitlement to benefits as set forth in this Act is | ||||||
18 | null and void. Nothing in this Section shall be construed as | ||||||
19 | creating a mandatory subject of bargaining. | ||||||
20 | (d) Form of agreement. The agreement reached herein shall | ||||||
21 | demonstrate that: | ||||||
22 | (1) The construction employer or group of construction | ||||||
23 | employers and the recognized or certified exclusive | ||||||
24 | bargaining representative have entered into a binding | ||||||
25 | collective bargaining agreement adopting the ADR plan for a | ||||||
26 | period of no less than 2 years; |
| |||||||
| |||||||
1 | (2) Contractual agreements have been reached with the | ||||||
2 | construction employer's workers' compensation carrier, | ||||||
3 | group self-insurance fund, and any excess carriers | ||||||
4 | relating to the ADR plan; | ||||||
5 | (3) Procedures have been established by which claims | ||||||
6 | for benefits by employees will be lodged, administered, and | ||||||
7 | decided while affording procedural due process; | ||||||
8 | (4) The plan has designated forms upon which claims for | ||||||
9 | benefits shall be made; | ||||||
10 | (5) The system and means by which the construction | ||||||
11 | employer's obligation to furnish medical services and | ||||||
12 | vocational rehabilitation and retraining benefits shall be | ||||||
13 | fulfilled and provider selected; | ||||||
14 | (6) The method by which mediators or arbitrators are to | ||||||
15 | be selected. | ||||||
16 | (e) Filing. A copy of the agreement and a statement | ||||||
17 | identifying the parties to the agreement shall be filed with | ||||||
18 | the Commission. Within 21 days of receipt of an agreement, the | ||||||
19 | Chairman shall review the agreement for compliance with this | ||||||
20 | Section and notify the parties of its acceptance or notify the | ||||||
21 | parties of any additional information required or any | ||||||
22 | recommended modification that would bring the agreement into | ||||||
23 | compliance. If no additional information or modification is | ||||||
24 | required, the agreement shall be valid and binding from the | ||||||
25 | time the parties receive acceptance of the agreement from the | ||||||
26 | Chairman. Upon receipt of any requested information or |
| |||||||
| |||||||
1 | modification, the Chairman shall notify the parties within 21 | ||||||
2 | days whether the agreement is in compliance with this Section. | ||||||
3 | All rejections made by the Chairman under this subsection shall | ||||||
4 | be subject to review by the courts of this State, said review | ||||||
5 | to be taken in the same manner and within the same time as | ||||||
6 | provided by Section 19 of this Act for review of awards and | ||||||
7 | decisions of the Commission. Upon the review, the Circuit Court | ||||||
8 | shall have power to review all questions of fact as well as of | ||||||
9 | law. | ||||||
10 | (f) Notice to insurance carrier. If the construction | ||||||
11 | employer is insured under this Act, it shall provide notice to | ||||||
12 | and obtain consent from its insurance carrier, in the manner | ||||||
13 | provided in the insurance contract, of its intent to enter into | ||||||
14 | an agreement as provided in this Section with its employees. | ||||||
15 | (g) Employees' claims for workers' compensation benefits. | ||||||
16 | (1) Claims for benefits shall be filed with the ADR | ||||||
17 | plan administrator within those periods of limitation | ||||||
18 | prescribed by this Act. Within 10 days of the filing of a | ||||||
19 | claim, the ADR plan administrator shall serve a copy of the | ||||||
20 | claim application upon the Commission, which shall | ||||||
21 | maintain records of all ADR claims and resolutions. | ||||||
22 | (2) Settlements of claims presented to the ADR plan | ||||||
23 | administrator shall be evidenced by a settlement | ||||||
24 | agreement. All such settlements shall be filed with the ADR | ||||||
25 | plan administrator, who within 10 days shall forward a copy | ||||||
26 | to the Commission for recording. |
| |||||||
| |||||||
1 | (3) Upon assignment of claims, unless settled, | ||||||
2 | mediators and arbitrators shall render final orders | ||||||
3 | containing essential findings of fact, rulings of law and | ||||||
4 | referring to other matters as pertinent to the questions at | ||||||
5 | issue. The ADR plan administrator shall maintain a record | ||||||
6 | of the proceedings. | ||||||
7 | (h) Reporting requirements. Annually, each ADR plan | ||||||
8 | administrator shall submit a report to the Commission | ||||||
9 | containing the following information: | ||||||
10 | (1) The number of employees within the ADR program; | ||||||
11 | (2) The number of occurrences of work-related injuries | ||||||
12 | or diseases; | ||||||
13 | (3) The breakdown within the ADR program of injuries | ||||||
14 | and diseases treated; | ||||||
15 | (4) The total amount of disability benefits paid within | ||||||
16 | the ADR program; | ||||||
17 | (5) The total medical treatment cost paid within the | ||||||
18 | ADR program; | ||||||
19 | (6) The number of claims filed within the ADR program; | ||||||
20 | and | ||||||
21 | (7) The disposition of all claims.
| ||||||
22 | (820 ILCS 305/8) (from Ch. 48, par. 138.8)
| ||||||
23 | Sec. 8. The amount of compensation which shall be paid to | ||||||
24 | the
employee for an accidental injury not resulting in death | ||||||
25 | is:
|
| |||||||
| |||||||
1 | (a) The employer shall provide and pay the negotiated rate, | ||||||
2 | if applicable, or the lesser of the health care provider's | ||||||
3 | actual charges or according to a fee schedule, subject to | ||||||
4 | Section 8.2, in effect at the time the service was rendered for | ||||||
5 | all the necessary first
aid, medical and surgical services, and | ||||||
6 | all necessary medical, surgical
and hospital services | ||||||
7 | thereafter incurred, limited, however, to that
which is | ||||||
8 | reasonably required to cure or relieve from the effects of the
| ||||||
9 | accidental injury , even if a health care provider sells, | ||||||
10 | transfers, or otherwise assigns an account receivable for | ||||||
11 | procedures, treatments, or services covered under this Act . If | ||||||
12 | the employer does not dispute payment of first aid, medical, | ||||||
13 | surgical,
and hospital services, the employer shall make such | ||||||
14 | payment to the provider on behalf of the employee. The employer | ||||||
15 | shall also pay for treatment,
instruction and training | ||||||
16 | necessary for the physical, mental and
vocational | ||||||
17 | rehabilitation of the employee, including all maintenance
| ||||||
18 | costs and expenses incidental thereto. If as a result of the | ||||||
19 | injury the
employee is unable to be self-sufficient the | ||||||
20 | employer shall further pay
for such maintenance or | ||||||
21 | institutional care as shall be required.
| ||||||
22 | The employee may at any time elect to secure his own | ||||||
23 | physician,
surgeon and hospital services at the employer's | ||||||
24 | expense, or, | ||||||
25 | Upon agreement between the employer and the employees, or | ||||||
26 | the employees'
exclusive representative, and subject to the |
| |||||||
| |||||||
1 | approval of the Illinois Workers' Compensation
Commission, the | ||||||
2 | employer shall maintain a list of physicians, to be
known as a | ||||||
3 | Panel of Physicians, who are accessible to the employees.
The | ||||||
4 | employer shall post this list in a place or places easily | ||||||
5 | accessible
to his employees. The employee shall have the right | ||||||
6 | to make an
alternative choice of physician from such Panel if | ||||||
7 | he is not satisfied
with the physician first selected. If, due | ||||||
8 | to the nature of the injury
or its occurrence away from the | ||||||
9 | employer's place of business, the
employee is unable to make a | ||||||
10 | selection from the Panel, the selection
process from the Panel | ||||||
11 | shall not apply. The physician selected from the
Panel may | ||||||
12 | arrange for any consultation, referral or other specialized
| ||||||
13 | medical services outside the Panel at the employer's expense. | ||||||
14 | Provided
that, in the event the Commission shall find that a | ||||||
15 | doctor selected by
the employee is rendering improper or | ||||||
16 | inadequate care, the Commission
may order the employee to | ||||||
17 | select another doctor certified or qualified
in the medical | ||||||
18 | field for which treatment is required. If the employee
refuses | ||||||
19 | to make such change the Commission may relieve the employer of
| ||||||
20 | his obligation to pay the doctor's charges from the date of | ||||||
21 | refusal to
the date of compliance.
| ||||||
22 | Any vocational rehabilitation counselors who provide | ||||||
23 | service under this Act shall have
appropriate certifications | ||||||
24 | which designate the counselor as qualified to render
opinions | ||||||
25 | relating to vocational rehabilitation. Vocational | ||||||
26 | rehabilitation
may include, but is not limited to, counseling |
| |||||||
| |||||||
1 | for job searches, supervising
a job search program, and | ||||||
2 | vocational retraining including education at an
accredited | ||||||
3 | learning institution. The employee or employer may petition to | ||||||
4 | the Commission to decide disputes relating to vocational | ||||||
5 | rehabilitation and the Commission shall resolve any such | ||||||
6 | dispute, including payment of the vocational rehabilitation | ||||||
7 | program by the employer. | ||||||
8 | The maintenance benefit shall not be less than the | ||||||
9 | temporary total disability
rate determined for the employee. In | ||||||
10 | addition, maintenance shall include costs
and expenses | ||||||
11 | incidental to the vocational rehabilitation program. | ||||||
12 | When the employee is working light duty on a part-time | ||||||
13 | basis or full-time
basis
and earns less than he or she would be | ||||||
14 | earning if employed in the full capacity
of the job or jobs, | ||||||
15 | then the employee shall be entitled to temporary partial | ||||||
16 | disability benefits. Temporary partial disability benefits | ||||||
17 | shall be
equal to two-thirds of
the difference between the | ||||||
18 | average amount that the employee would be able to
earn in the | ||||||
19 | full performance of his or her duties in the occupation in | ||||||
20 | which he
or she was engaged at the time of accident and the | ||||||
21 | gross net amount which he or she
is
earning in the modified job | ||||||
22 | provided to the employee by the employer or in any other job | ||||||
23 | that the employee is working. | ||||||
24 | Every hospital, physician, surgeon or other person | ||||||
25 | rendering
treatment or services in accordance with the | ||||||
26 | provisions of this Section
shall upon written request furnish |
| |||||||
| |||||||
1 | full and complete reports thereof to,
and permit their records | ||||||
2 | to be copied by, the employer, the employee or
his dependents, | ||||||
3 | as the case may be, or any other party to any proceeding
for | ||||||
4 | compensation before the Commission, or their attorneys.
| ||||||
5 | Notwithstanding the foregoing, the employer's liability to | ||||||
6 | pay for such
medical services selected by the employee shall be | ||||||
7 | limited to:
| ||||||
8 | (1) all first aid and emergency treatment; plus
| ||||||
9 | (2) all medical, surgical and hospital services | ||||||
10 | provided by the
physician, surgeon or hospital initially | ||||||
11 | chosen by the employee or by any
other physician, | ||||||
12 | consultant, expert, institution or other provider of
| ||||||
13 | services recommended by said initial service provider or | ||||||
14 | any subsequent
provider of medical services in the chain of | ||||||
15 | referrals from said
initial service provider; plus
| ||||||
16 |
(3) all medical, surgical and hospital services | ||||||
17 | provided by any second
physician, surgeon or hospital | ||||||
18 | subsequently chosen by the employee or by
any other | ||||||
19 | physician, consultant, expert, institution or other | ||||||
20 | provider of
services recommended by said second service | ||||||
21 | provider or any subsequent provider
of medical services in | ||||||
22 | the chain of referrals
from said second service provider. | ||||||
23 | Thereafter the employer shall select
and pay for all | ||||||
24 | necessary medical, surgical and hospital treatment and the
| ||||||
25 | employee may not select a provider of medical services at | ||||||
26 | the employer's
expense unless the employer agrees to such |
| |||||||
| |||||||
1 | selection. At any time the employee
may obtain any medical | ||||||
2 | treatment he desires at his own expense. This paragraph
| ||||||
3 | shall not affect the duty to pay for rehabilitation | ||||||
4 | referred to above.
| ||||||
5 | (4) The following shall apply for injuries occurring on | ||||||
6 | or after the effective date of this amendatory Act of the | ||||||
7 | 97th General Assembly and only when an employer has an | ||||||
8 | approved preferred provider program pursuant to Section | ||||||
9 | 8.1a on the date the employee sustained his or her | ||||||
10 | accidental injuries: | ||||||
11 | (A) The employer shall, in writing, on a form | ||||||
12 | promulgated by the Commission, inform the employee of | ||||||
13 | the preferred provider program; | ||||||
14 | (B) Subsequent to the report of an injury by an | ||||||
15 | employee, the employee may choose in writing at any | ||||||
16 | time to decline the preferred provider program, in | ||||||
17 | which case that would constitute one of the two choices | ||||||
18 | of medical providers to which the employee is entitled | ||||||
19 | under subsection (a)(2) or (a)(3); and | ||||||
20 | (C) Prior to the report of an injury by an | ||||||
21 | employee, when an employee chooses non-emergency | ||||||
22 | treatment from a provider not within the preferred | ||||||
23 | provider program, that would constitute the employee's | ||||||
24 | one choice of medical providers to which the employee | ||||||
25 | is entitled under subsection (a)(2) or (a)(3). | ||||||
26 | When an employer and employee so agree in writing, nothing |
| |||||||
| |||||||
1 | in this
Act prevents an employee whose injury or disability has | ||||||
2 | been established
under this Act, from relying in good faith, on | ||||||
3 | treatment by prayer or
spiritual means alone, in accordance | ||||||
4 | with the tenets and practice of a
recognized church or | ||||||
5 | religious denomination, by a duly accredited
practitioner | ||||||
6 | thereof, and having nursing services appropriate therewith,
| ||||||
7 | without suffering loss or diminution of the compensation | ||||||
8 | benefits under
this Act. However, the employee shall submit to | ||||||
9 | all physical
examinations required by this Act. The cost of | ||||||
10 | such treatment and
nursing care shall be paid by the employee | ||||||
11 | unless the employer agrees to
make such payment.
| ||||||
12 | Where the accidental injury results in the amputation of an | ||||||
13 | arm,
hand, leg or foot, or the enucleation of an eye, or the | ||||||
14 | loss of any of
the natural teeth, the employer shall furnish an | ||||||
15 | artificial of any such
members lost or damaged in accidental | ||||||
16 | injury arising out of and in the
course of employment, and | ||||||
17 | shall also furnish the necessary braces in all
proper and | ||||||
18 | necessary cases. In cases of the loss of a member or members
by | ||||||
19 | amputation, the employer shall, whenever necessary, maintain | ||||||
20 | in good
repair, refit or replace the artificial limbs during | ||||||
21 | the lifetime of the
employee. Where the accidental injury | ||||||
22 | accompanied by physical injury
results in damage to a denture, | ||||||
23 | eye glasses or contact eye lenses, or
where the accidental | ||||||
24 | injury results in damage to an artificial member,
the employer | ||||||
25 | shall replace or repair such denture, glasses, lenses, or
| ||||||
26 | artificial member.
|
| |||||||
| |||||||
1 | The furnishing by the employer of any such services or | ||||||
2 | appliances is
not an admission of liability on the part of the | ||||||
3 | employer to pay
compensation.
| ||||||
4 | The furnishing of any such services or appliances or the | ||||||
5 | servicing
thereof by the employer is not the payment of | ||||||
6 | compensation.
| ||||||
7 | (b) If the period of temporary total incapacity for work | ||||||
8 | lasts more
than 3 working days, weekly compensation as | ||||||
9 | hereinafter provided shall
be paid beginning on the 4th day of | ||||||
10 | such temporary total incapacity and
continuing as long as the | ||||||
11 | total temporary incapacity lasts. In cases
where the temporary | ||||||
12 | total incapacity for work continues for a period of
14 days or | ||||||
13 | more from the day of the accident compensation shall commence
| ||||||
14 | on the day after the accident.
| ||||||
15 | 1. The compensation rate for temporary total | ||||||
16 | incapacity under this
paragraph (b) of this Section shall | ||||||
17 | be equal to 66 2/3% of the
employee's average weekly wage | ||||||
18 | computed in accordance with Section 10,
provided that it | ||||||
19 | shall be not less than 66 2/3% of the sum of the Federal | ||||||
20 | minimum wage under the Fair Labor
Standards Act, or the | ||||||
21 | Illinois minimum wage under the Minimum Wage Law,
whichever | ||||||
22 | is more, multiplied by 40 hours. This percentage rate shall | ||||||
23 | be
increased by 10% for each spouse and child, not to | ||||||
24 | exceed 100% of the total
minimum wage calculation,
| ||||||
25 | nor exceed the employee's average weekly wage computed in | ||||||
26 | accordance
with the provisions of Section 10, whichever is |
| |||||||
| |||||||
1 | less.
| ||||||
2 | 2. The compensation rate in all cases other than for | ||||||
3 | temporary total
disability under this paragraph (b), and | ||||||
4 | other than for serious and
permanent disfigurement under | ||||||
5 | paragraph (c) and other than for permanent
partial | ||||||
6 | disability under subparagraph (2) of paragraph (d) or under
| ||||||
7 | paragraph (e), of this Section shall be equal to 66
2/3% of | ||||||
8 | the employee's average weekly wage computed in accordance | ||||||
9 | with
the provisions of Section 10, provided that it shall | ||||||
10 | be not less than
66 2/3% of the sum of the Federal minimum | ||||||
11 | wage under the Fair Labor Standards Act, or the Illinois | ||||||
12 | minimum wage under the Minimum Wage Law, whichever is more, | ||||||
13 | multiplied by 40 hours. This percentage rate shall be | ||||||
14 | increased by 10% for each spouse and child, not to exceed | ||||||
15 | 100% of the total minimum wage calculation,
| ||||||
16 | nor exceed the employee's average weekly wage computed in | ||||||
17 | accordance
with the provisions of Section 10, whichever is | ||||||
18 | less.
| ||||||
19 | 2.1. The compensation rate in all cases of serious and | ||||||
20 | permanent
disfigurement under paragraph (c) and of | ||||||
21 | permanent partial disability
under subparagraph (2) of | ||||||
22 | paragraph (d) or under paragraph (e) of this
Section shall | ||||||
23 | be equal to
60% of the employee's average
weekly wage | ||||||
24 | computed in accordance with
the provisions of Section 10, | ||||||
25 | provided that it shall be not less than
66 2/3% of the sum | ||||||
26 | of the Federal minimum wage under the Fair Labor Standards |
| |||||||
| |||||||
1 | Act, or the Illinois minimum wage under the Minimum Wage | ||||||
2 | Law, whichever is more, multiplied by 40 hours. This | ||||||
3 | percentage rate shall be increased by 10% for each spouse | ||||||
4 | and child, not to exceed 100% of the total minimum wage | ||||||
5 | calculation,
| ||||||
6 | nor exceed the employee's average weekly wage computed in | ||||||
7 | accordance
with the provisions of Section 10, whichever is | ||||||
8 | less.
| ||||||
9 | 3. As used in this Section the term "child" means a | ||||||
10 | child of the
employee including any child legally adopted | ||||||
11 | before the accident or whom
at the time of the accident the | ||||||
12 | employee was under legal obligation to
support or to whom | ||||||
13 | the employee stood in loco parentis, and who at the
time of | ||||||
14 | the accident was under 18 years of age and not emancipated. | ||||||
15 | The
term "children" means the plural of "child".
| ||||||
16 | 4. All weekly compensation rates provided under | ||||||
17 | subparagraphs 1,
2 and 2.1 of this paragraph (b) of this | ||||||
18 | Section shall be subject to the
following limitations:
| ||||||
19 | The maximum weekly compensation rate from July 1, 1975, | ||||||
20 | except as
hereinafter provided, shall be 100% of the | ||||||
21 | State's average weekly wage in
covered industries under the | ||||||
22 | Unemployment Insurance Act, that being the
wage that most | ||||||
23 | closely approximates the State's average weekly wage.
| ||||||
24 | The maximum weekly compensation rate, for the period | ||||||
25 | July 1, 1984,
through June 30, 1987, except as hereinafter | ||||||
26 | provided, shall be $293.61.
Effective July 1, 1987 and on |
| |||||||
| |||||||
1 | July 1 of each year thereafter the maximum
weekly | ||||||
2 | compensation rate, except as hereinafter provided, shall | ||||||
3 | be
determined as follows: if during the preceding 12 month | ||||||
4 | period there shall
have been an increase in the State's | ||||||
5 | average weekly wage in covered
industries under the | ||||||
6 | Unemployment Insurance Act, the weekly compensation
rate | ||||||
7 | shall be proportionately increased by the same percentage | ||||||
8 | as the
percentage of increase in the State's average weekly | ||||||
9 | wage in covered
industries under the Unemployment | ||||||
10 | Insurance Act during such period.
| ||||||
11 | The maximum weekly compensation rate, for the period | ||||||
12 | January 1, 1981
through December 31, 1983, except as | ||||||
13 | hereinafter provided, shall be 100% of
the State's average | ||||||
14 | weekly wage in covered industries under the
Unemployment | ||||||
15 | Insurance Act in effect on January 1, 1981. Effective | ||||||
16 | January
1, 1984 and on January 1, of each year thereafter | ||||||
17 | the maximum weekly
compensation rate, except as | ||||||
18 | hereinafter provided, shall be determined as
follows: if | ||||||
19 | during the preceding 12 month period there shall have been | ||||||
20 | an
increase in the State's average weekly wage in covered | ||||||
21 | industries under the
Unemployment Insurance Act, the | ||||||
22 | weekly compensation rate shall be
proportionately | ||||||
23 | increased by the same percentage as the percentage of
| ||||||
24 | increase in the State's average weekly wage in covered | ||||||
25 | industries under the
Unemployment Insurance Act during | ||||||
26 | such period.
|
| |||||||
| |||||||
1 | From July 1, 1977 and thereafter such maximum weekly | ||||||
2 | compensation
rate in death cases under Section 7, and | ||||||
3 | permanent total disability
cases under paragraph (f) or | ||||||
4 | subparagraph 18 of paragraph (3) of this
Section and for | ||||||
5 | temporary total disability under paragraph (b) of this
| ||||||
6 | Section and for amputation of a member or enucleation of an | ||||||
7 | eye under
paragraph (e) of this Section shall be increased | ||||||
8 | to 133-1/3% of the
State's average weekly wage in covered | ||||||
9 | industries under the
Unemployment Insurance Act.
| ||||||
10 | For injuries occurring on or after February 1, 2006, | ||||||
11 | the maximum weekly benefit under paragraph (d)1 of this | ||||||
12 | Section shall be 100% of the State's average weekly wage in | ||||||
13 | covered industries under the Unemployment Insurance Act.
| ||||||
14 | 4.1. Any provision herein to the contrary | ||||||
15 | notwithstanding, the
weekly compensation rate for | ||||||
16 | compensation payments under subparagraph 18
of paragraph | ||||||
17 | (e) of this Section and under paragraph (f) of this
Section | ||||||
18 | and under paragraph (a) of Section 7 and for amputation of | ||||||
19 | a member or enucleation of an eye under paragraph (e) of | ||||||
20 | this Section, shall in no event be less
than 50% of the | ||||||
21 | State's average weekly wage in covered industries under
the | ||||||
22 | Unemployment Insurance Act.
| ||||||
23 | 4.2. Any provision to the contrary notwithstanding, | ||||||
24 | the total
compensation payable under Section 7 shall not | ||||||
25 | exceed the greater of $500,000
or 25
years.
| ||||||
26 | 5. For the purpose of this Section this State's average |
| |||||||
| |||||||
1 | weekly wage
in covered industries under the Unemployment | ||||||
2 | Insurance Act on
July 1, 1975 is hereby fixed at $228.16 | ||||||
3 | per
week and the computation of compensation rates shall be | ||||||
4 | based on the
aforesaid average weekly wage until modified | ||||||
5 | as hereinafter provided.
| ||||||
6 | 6. The Department of Employment Security of the State | ||||||
7 | shall
on or before the first day of December, 1977, and on | ||||||
8 | or before the first
day of June, 1978, and on the first day | ||||||
9 | of each December and June of each
year thereafter, publish | ||||||
10 | the State's average weekly wage in covered
industries under | ||||||
11 | the Unemployment Insurance Act and the Illinois Workers' | ||||||
12 | Compensation
Commission shall on the 15th day of January, | ||||||
13 | 1978 and on the 15th day of
July, 1978 and on the 15th day | ||||||
14 | of each January and July of each year
thereafter, post and | ||||||
15 | publish the State's average weekly wage in covered
| ||||||
16 | industries under the Unemployment Insurance Act as last | ||||||
17 | determined and
published by the Department of Employment | ||||||
18 | Security. The amount when so
posted and published shall be | ||||||
19 | conclusive and shall be applicable as the
basis of | ||||||
20 | computation of compensation rates until the next posting | ||||||
21 | and
publication as aforesaid.
| ||||||
22 | 7. The payment of compensation by an employer or his | ||||||
23 | insurance
carrier to an injured employee shall not | ||||||
24 | constitute an admission of the
employer's liability to pay | ||||||
25 | compensation.
| ||||||
26 | (c) For any serious and permanent disfigurement to the |
| |||||||
| |||||||
1 | hand, head,
face, neck, arm, leg below the knee or the chest | ||||||
2 | above the axillary
line, the employee is entitled to | ||||||
3 | compensation for such disfigurement,
the amount determined by | ||||||
4 | agreement at any time or by arbitration under
this Act, at a | ||||||
5 | hearing not less than 6 months after the date of the
accidental | ||||||
6 | injury, which amount shall not exceed 150 weeks (if the | ||||||
7 | accidental injury occurs on or after the effective date of this | ||||||
8 | amendatory Act of the 94th General Assembly
but before February
| ||||||
9 | 1, 2006) or 162
weeks (if the accidental injury occurs on or | ||||||
10 | after February
1, 2006) at the
applicable rate provided in | ||||||
11 | subparagraph 2.1 of paragraph (b) of this Section.
| ||||||
12 | No compensation is payable under this paragraph where | ||||||
13 | compensation is
payable under paragraphs (d), (e) or (f) of | ||||||
14 | this Section.
| ||||||
15 | A duly appointed member of a fire department in a city, the | ||||||
16 | population of
which exceeds 200,000 according to the last | ||||||
17 | federal or State census, is
eligible for compensation under | ||||||
18 | this paragraph only where such serious and
permanent | ||||||
19 | disfigurement results from burns.
| ||||||
20 | (d) 1. If, after the accidental injury has been sustained, | ||||||
21 | the
employee as a result thereof becomes partially | ||||||
22 | incapacitated from
pursuing his usual and customary line of | ||||||
23 | employment, he shall, except in
cases compensated under the | ||||||
24 | specific schedule set forth in paragraph (e)
of this Section, | ||||||
25 | receive compensation for the duration of his
disability, | ||||||
26 | subject to the limitations as to maximum amounts fixed in
|
| |||||||
| |||||||
1 | paragraph (b) of this Section, equal to 66-2/3% of the | ||||||
2 | difference
between the average amount which he would be able to | ||||||
3 | earn in the full
performance of his duties in the occupation in | ||||||
4 | which he was engaged at
the time of the accident and the | ||||||
5 | average amount which he is earning or
is able to earn in some | ||||||
6 | suitable employment or business after the accident. For | ||||||
7 | accidental injuries that occur on or after September 1, 2011, | ||||||
8 | an award for wage differential under this subsection shall be | ||||||
9 | effective only until the employee reaches the age of 67 or 5 | ||||||
10 | years from the date the award becomes final, whichever is | ||||||
11 | later.
| ||||||
12 | 2. If, as a result of the accident, the employee sustains | ||||||
13 | serious
and permanent injuries not covered by paragraphs (c) | ||||||
14 | and (e) of this
Section or having sustained injuries covered by | ||||||
15 | the aforesaid
paragraphs (c) and (e), he shall have sustained | ||||||
16 | in addition thereto
other injuries which injuries do not | ||||||
17 | incapacitate him from pursuing the
duties of his employment but | ||||||
18 | which would disable him from pursuing other
suitable | ||||||
19 | occupations, or which have otherwise resulted in physical
| ||||||
20 | impairment; or if such injuries partially incapacitate him from | ||||||
21 | pursuing
the duties of his usual and customary line of | ||||||
22 | employment but do not
result in an impairment of earning | ||||||
23 | capacity, or having resulted in an
impairment of earning | ||||||
24 | capacity, the employee elects to waive his right
to recover | ||||||
25 | under the foregoing subparagraph 1 of paragraph (d) of this
| ||||||
26 | Section then in any of the foregoing events, he shall receive |
| |||||||
| |||||||
1 | in
addition to compensation for temporary total disability | ||||||
2 | under paragraph
(b) of this Section, compensation at the rate | ||||||
3 | provided in subparagraph 2.1
of paragraph (b) of this Section | ||||||
4 | for that percentage of 500 weeks that
the partial disability | ||||||
5 | resulting from the injuries covered by this
paragraph bears to | ||||||
6 | total disability. If the employee shall have
sustained a | ||||||
7 | fracture of one or more vertebra or fracture of the skull,
the | ||||||
8 | amount of compensation allowed under this Section shall be not | ||||||
9 | less
than 6 weeks for a fractured skull and 6 weeks for each | ||||||
10 | fractured
vertebra, and in the event the employee shall have | ||||||
11 | sustained a fracture
of any of the following facial bones: | ||||||
12 | nasal, lachrymal, vomer, zygoma,
maxilla, palatine or | ||||||
13 | mandible, the amount of compensation allowed under
this Section | ||||||
14 | shall be not less than 2 weeks for each such fractured
bone, | ||||||
15 | and for a fracture of each transverse process not less than 3
| ||||||
16 | weeks. In the event such injuries shall result in the loss of a | ||||||
17 | kidney,
spleen or lung, the amount of compensation allowed | ||||||
18 | under this Section
shall be not less than 10 weeks for each | ||||||
19 | such organ. Compensation
awarded under this subparagraph 2 | ||||||
20 | shall not take into consideration
injuries covered under | ||||||
21 | paragraphs (c) and (e) of this Section and the
compensation | ||||||
22 | provided in this paragraph shall not affect the employee's
| ||||||
23 | right to compensation payable under paragraphs (b), (c) and (e) | ||||||
24 | of this
Section for the disabilities therein covered.
| ||||||
25 | (e) For accidental injuries in the following schedule, the | ||||||
26 | employee
shall receive compensation for the period of temporary |
| |||||||
| |||||||
1 | total incapacity
for work resulting from such accidental | ||||||
2 | injury, under subparagraph 1 of
paragraph (b) of this Section, | ||||||
3 | and shall receive in addition thereto
compensation for a | ||||||
4 | further period for the specific loss herein
mentioned, but | ||||||
5 | shall not receive any compensation under any other
provisions | ||||||
6 | of this Act. The following listed amounts apply to either
the | ||||||
7 | loss of or the permanent and complete loss of use of the member
| ||||||
8 | specified, such compensation for the length of time as follows:
| ||||||
9 | 1. Thumb- | ||||||
10 | 70 weeks if the accidental injury occurs on or | ||||||
11 | after the effective date of this amendatory Act of the | ||||||
12 | 94th General Assembly
but before February
1, 2006.
| ||||||
13 | 76
weeks if the accidental injury occurs on or | ||||||
14 | after February
1, 2006.
| ||||||
15 | 2. First, or index finger- | ||||||
16 | 40 weeks if the accidental injury occurs on or | ||||||
17 | after the effective date of this amendatory Act of the | ||||||
18 | 94th General Assembly
but before February
1, 2006.
| ||||||
19 | 43
weeks if the accidental injury occurs on or | ||||||
20 | after February
1, 2006.
| ||||||
21 | 3. Second, or middle finger- | ||||||
22 | 35 weeks if the accidental injury occurs on or | ||||||
23 | after the effective date of this amendatory Act of the | ||||||
24 | 94th General Assembly
but before February
1, 2006.
| ||||||
25 | 38
weeks if the accidental injury occurs on or | ||||||
26 | after February
1, 2006.
|
| |||||||
| |||||||
1 | 4. Third, or ring finger- | ||||||
2 | 25 weeks if the accidental injury occurs on or | ||||||
3 | after the effective date of this amendatory Act of the | ||||||
4 | 94th General Assembly
but before February
1, 2006.
| ||||||
5 | 27
weeks if the accidental injury occurs on or | ||||||
6 | after February
1, 2006.
| ||||||
7 | 5. Fourth, or little finger- | ||||||
8 | 20 weeks if the accidental injury occurs on or | ||||||
9 | after the effective date of this amendatory Act of the | ||||||
10 | 94th General Assembly
but before February
1, 2006.
| ||||||
11 | 22
weeks if the accidental injury occurs on or | ||||||
12 | after February
1, 2006.
| ||||||
13 | 6. Great toe- | ||||||
14 | 35 weeks if the accidental injury occurs on or | ||||||
15 | after the effective date of this amendatory Act of the | ||||||
16 | 94th General Assembly
but before February
1, 2006.
| ||||||
17 | 38
weeks if the accidental injury occurs on or | ||||||
18 | after February
1, 2006.
| ||||||
19 | 7. Each toe other than great toe- | ||||||
20 | 12 weeks if the accidental injury occurs on or | ||||||
21 | after the effective date of this amendatory Act of the | ||||||
22 | 94th General Assembly
but before February
1, 2006.
| ||||||
23 | 13
weeks if the accidental injury occurs on or | ||||||
24 | after February
1, 2006.
| ||||||
25 | 8. The loss of the first or distal phalanx of the thumb | ||||||
26 | or of any
finger or toe shall be considered to be equal to |
| |||||||
| |||||||
1 | the loss of one-half of
such thumb, finger or toe and the | ||||||
2 | compensation payable shall be one-half
of the amount above | ||||||
3 | specified. The loss of more than one phalanx shall
be | ||||||
4 | considered as the loss of the entire thumb, finger or toe. | ||||||
5 | In no
case shall the amount received for more than one | ||||||
6 | finger exceed the
amount provided in this schedule for the | ||||||
7 | loss of a hand.
| ||||||
8 | 9. Hand- | ||||||
9 | 190 weeks if the accidental injury occurs on or | ||||||
10 | after the effective date of this amendatory Act of the | ||||||
11 | 94th General Assembly
but before February
1, 2006.
| ||||||
12 | 205
weeks if the accidental injury occurs on or | ||||||
13 | after February
1, 2006. | ||||||
14 | 190 weeks if the accidental injury occurs on or | ||||||
15 | after the effective date of this amendatory Act of the | ||||||
16 | 97th General Assembly and if the accidental injury | ||||||
17 | involves carpal tunnel syndrome due to repetitive or | ||||||
18 | cumulative trauma, in which case the permanent partial | ||||||
19 | disability shall not exceed 15% loss of use of the | ||||||
20 | hand, except for cause shown by clear and convincing | ||||||
21 | evidence and in which case the award shall not exceed | ||||||
22 | 30% loss of use of the hand. | ||||||
23 | The loss of 2 or more digits, or one or more
phalanges | ||||||
24 | of 2 or more digits, of a hand may be compensated on the | ||||||
25 | basis
of partial loss of use of a hand, provided, further, | ||||||
26 | that the loss of 4
digits, or the loss of use of 4 digits, |
| |||||||
| |||||||
1 | in the same hand shall
constitute the complete loss of a | ||||||
2 | hand.
| ||||||
3 | 10. Arm- | ||||||
4 | 235 weeks if the accidental injury occurs on or | ||||||
5 | after the effective date of this amendatory Act of the | ||||||
6 | 94th General Assembly
but before February
1, 2006.
| ||||||
7 | 253
weeks if the accidental injury occurs on or | ||||||
8 | after February
1, 2006. | ||||||
9 | Where an accidental injury results in the
amputation of | ||||||
10 | an arm below the elbow, such injury shall be compensated
as | ||||||
11 | a loss of an arm. Where an accidental injury results in the
| ||||||
12 | amputation of an arm above the elbow, compensation for an | ||||||
13 | additional 15 weeks (if the accidental injury occurs on or | ||||||
14 | after the effective date of this amendatory Act of the 94th | ||||||
15 | General Assembly
but before February
1, 2006) or an | ||||||
16 | additional 17
weeks (if the accidental injury occurs on or | ||||||
17 | after February
1, 2006) shall be paid, except where the | ||||||
18 | accidental injury results in the
amputation of an arm at | ||||||
19 | the shoulder joint, or so close to shoulder
joint that an | ||||||
20 | artificial arm cannot be used, or results in the
| ||||||
21 | disarticulation of an arm at the shoulder joint, in which | ||||||
22 | case
compensation for an additional 65 weeks (if the | ||||||
23 | accidental injury occurs on or after the effective date of | ||||||
24 | this amendatory Act of the 94th General Assembly
but before | ||||||
25 | February
1, 2006) or an additional 70
weeks (if the | ||||||
26 | accidental injury occurs on or after February
1, 2006)
|
| |||||||
| |||||||
1 | shall be paid.
| ||||||
2 | 11. Foot- | ||||||
3 | 155 weeks if the accidental injury occurs on or | ||||||
4 | after the effective date of this amendatory Act of the | ||||||
5 | 94th General Assembly
but before February
1, 2006.
| ||||||
6 | 167
weeks if the accidental injury occurs on or | ||||||
7 | after February
1, 2006.
| ||||||
8 | 12. Leg- | ||||||
9 | 200 weeks if the accidental injury occurs on or | ||||||
10 | after the effective date of this amendatory Act of the | ||||||
11 | 94th General Assembly
but before February
1, 2006.
| ||||||
12 | 215
weeks if the accidental injury occurs on or | ||||||
13 | after February
1, 2006. | ||||||
14 | Where an accidental injury results in the
amputation of | ||||||
15 | a leg below the knee, such injury shall be compensated as
| ||||||
16 | loss of a leg. Where an accidental injury results in the | ||||||
17 | amputation of a
leg above the knee, compensation for an | ||||||
18 | additional 25 weeks (if the accidental injury occurs on or | ||||||
19 | after the effective date of this amendatory Act of the 94th | ||||||
20 | General Assembly
but before February
1, 2006) or an | ||||||
21 | additional 27
weeks (if the accidental injury occurs on or | ||||||
22 | after February
1, 2006) shall be
paid, except where the | ||||||
23 | accidental injury results in the amputation of a
leg at the | ||||||
24 | hip joint, or so close to the hip joint that an artificial
| ||||||
25 | leg cannot be used, or results in the disarticulation of a | ||||||
26 | leg at the
hip joint, in which case compensation for an |
| |||||||
| |||||||
1 | additional 75 weeks (if the accidental injury occurs on or | ||||||
2 | after the effective date of this amendatory Act of the 94th | ||||||
3 | General Assembly
but before February
1, 2006) or an | ||||||
4 | additional 81
weeks (if the accidental injury occurs on or | ||||||
5 | after February
1, 2006) shall
be paid.
| ||||||
6 | 13. Eye- | ||||||
7 | 150 weeks if the accidental injury occurs on or | ||||||
8 | after the effective date of this amendatory Act of the | ||||||
9 | 94th General Assembly
but before February
1, 2006.
| ||||||
10 | 162
weeks if the accidental injury occurs on or | ||||||
11 | after February
1, 2006. | ||||||
12 | Where an accidental injury results in the
enucleation | ||||||
13 | of an eye, compensation for an additional 10 weeks (if the | ||||||
14 | accidental injury occurs on or after the effective date of | ||||||
15 | this amendatory Act of the 94th General Assembly
but before | ||||||
16 | February
1, 2006) or an additional 11
weeks (if the | ||||||
17 | accidental injury occurs on or after February
1, 2006)
| ||||||
18 | shall be
paid.
| ||||||
19 | 14. Loss of hearing of one ear- | ||||||
20 | 50 weeks if the accidental injury occurs on or | ||||||
21 | after the effective date of this amendatory Act of the | ||||||
22 | 94th General Assembly
but before February
1, 2006.
| ||||||
23 | 54
weeks if the accidental injury occurs on or | ||||||
24 | after February
1, 2006.
| ||||||
25 | Total and permanent loss of
hearing of both ears- | ||||||
26 | 200 weeks if the accidental injury occurs on or |
| |||||||
| |||||||
1 | after the effective date of this amendatory Act of the | ||||||
2 | 94th General Assembly
but before February
1, 2006. | ||||||
3 | 215
weeks if the accidental injury occurs on or | ||||||
4 | after February
1, 2006.
| ||||||
5 | 15. Testicle- | ||||||
6 | 50 weeks if the accidental injury occurs on or | ||||||
7 | after the effective date of this amendatory Act of the | ||||||
8 | 94th General Assembly
but before February
1, 2006.
| ||||||
9 | 54
weeks if the accidental injury occurs on or | ||||||
10 | after February
1, 2006.
| ||||||
11 | Both testicles- | ||||||
12 | 150 weeks if the accidental injury occurs on or | ||||||
13 | after the effective date of this amendatory Act of the | ||||||
14 | 94th General Assembly
but before February
1, 2006.
| ||||||
15 | 162
weeks if the accidental injury occurs on or | ||||||
16 | after February
1, 2006.
| ||||||
17 | 16. For the permanent partial loss of use of a member | ||||||
18 | or sight of an
eye, or hearing of an ear, compensation | ||||||
19 | during that proportion of the
number of weeks in the | ||||||
20 | foregoing schedule provided for the loss of such
member or | ||||||
21 | sight of an eye, or hearing of an ear, which the partial | ||||||
22 | loss
of use thereof bears to the total loss of use of such | ||||||
23 | member, or sight
of eye, or hearing of an ear.
| ||||||
24 | (a) Loss of hearing for compensation purposes | ||||||
25 | shall be
confined to the frequencies of 1,000, 2,000 | ||||||
26 | and 3,000 cycles per second.
Loss of hearing ability |
| |||||||
| |||||||
1 | for frequency tones above 3,000 cycles per second
are | ||||||
2 | not to be considered as constituting disability for | ||||||
3 | hearing.
| ||||||
4 | (b) The percent of hearing loss, for purposes of | ||||||
5 | the
determination of compensation claims for | ||||||
6 | occupational deafness,
shall be calculated as the | ||||||
7 | average in decibels for the thresholds
of hearing for | ||||||
8 | the frequencies of 1,000, 2,000 and 3,000 cycles per | ||||||
9 | second.
Pure tone air conduction audiometric | ||||||
10 | instruments, approved by
nationally recognized | ||||||
11 | authorities in this field, shall be used for measuring
| ||||||
12 | hearing loss. If the losses of hearing average 30 | ||||||
13 | decibels or less in the
3 frequencies, such losses of | ||||||
14 | hearing shall not then constitute any
compensable | ||||||
15 | hearing disability. If the losses of hearing average 85
| ||||||
16 | decibels or more in the 3 frequencies, then the same | ||||||
17 | shall constitute and
be total or 100% compensable | ||||||
18 | hearing loss.
| ||||||
19 | (c) In measuring hearing impairment, the lowest | ||||||
20 | measured
losses in each of the 3 frequencies shall be | ||||||
21 | added together and
divided by 3 to determine the | ||||||
22 | average decibel loss. For every decibel
of loss | ||||||
23 | exceeding 30 decibels an allowance of 1.82% shall be | ||||||
24 | made up to
the maximum of 100% which is reached at 85 | ||||||
25 | decibels.
| ||||||
26 | (d) If a hearing loss is established to have |
| ||||||||||||||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||
1 | existed on July 1, 1975 by
audiometric testing the | |||||||||||||||||||||||||||||||||||||||||||||
2 | employer shall not be liable for the previous loss
so | |||||||||||||||||||||||||||||||||||||||||||||
3 | established nor shall he be liable for any loss for | |||||||||||||||||||||||||||||||||||||||||||||
4 | which compensation
has been paid or awarded.
| |||||||||||||||||||||||||||||||||||||||||||||
5 | (e) No consideration shall be given to the question | |||||||||||||||||||||||||||||||||||||||||||||
6 | of
whether or not the ability of an employee to | |||||||||||||||||||||||||||||||||||||||||||||
7 | understand speech
is improved by the use of a hearing | |||||||||||||||||||||||||||||||||||||||||||||
8 | aid.
| |||||||||||||||||||||||||||||||||||||||||||||
9 | (f) No claim for loss of hearing due to industrial | |||||||||||||||||||||||||||||||||||||||||||||
10 | noise
shall be brought against an employer or allowed | |||||||||||||||||||||||||||||||||||||||||||||
11 | unless the employee has
been exposed for a period of | |||||||||||||||||||||||||||||||||||||||||||||
12 | time sufficient to cause permanent impairment
to noise | |||||||||||||||||||||||||||||||||||||||||||||
13 | levels in excess of the following:
| |||||||||||||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||
25 | This subparagraph (f) shall not be applied in cases of | |||||||||||||||||||||||||||||||||||||||||||||
26 | hearing loss
resulting from trauma or explosion.
|
| |||||||
| |||||||
1 | 17. In computing the compensation to be paid to any | ||||||
2 | employee who,
before the accident for which he claims | ||||||
3 | compensation, had before that
time sustained an injury | ||||||
4 | resulting in the loss by amputation or partial
loss by | ||||||
5 | amputation of any member, including hand, arm, thumb or | ||||||
6 | fingers,
leg, foot or any toes, such loss or partial loss | ||||||
7 | of any such member
shall be deducted from any award made | ||||||
8 | for the subsequent injury. For
the permanent loss of use or | ||||||
9 | the permanent partial loss of use of any
such member or the | ||||||
10 | partial loss of sight of an eye, for which
compensation has | ||||||
11 | been paid, then such loss shall be taken into
consideration | ||||||
12 | and deducted from any award for the subsequent injury.
| ||||||
13 | 18. The specific case of loss of both hands, both arms, | ||||||
14 | or both
feet, or both legs, or both eyes, or of any two | ||||||
15 | thereof, or the
permanent and complete loss of the use | ||||||
16 | thereof, constitutes total and
permanent disability, to be | ||||||
17 | compensated according to the compensation
fixed by | ||||||
18 | paragraph (f) of this Section. These specific cases of | ||||||
19 | total
and permanent disability do not exclude other cases.
| ||||||
20 | Any employee who has previously suffered the loss or | ||||||
21 | permanent and
complete loss of the use of any of such | ||||||
22 | members, and in a subsequent
independent accident loses | ||||||
23 | another or suffers the permanent and complete
loss of the | ||||||
24 | use of any one of such members the employer for whom the
| ||||||
25 | injured employee is working at the time of the last | ||||||
26 | independent accident
is liable to pay compensation only for |
| |||||||
| |||||||
1 | the loss or permanent and
complete loss of the use of the | ||||||
2 | member occasioned by the last
independent accident.
| ||||||
3 | 19. In a case of specific loss and the subsequent death | ||||||
4 | of such
injured employee from other causes than such injury | ||||||
5 | leaving a widow,
widower, or dependents surviving before | ||||||
6 | payment or payment in full for
such injury, then the amount | ||||||
7 | due for such injury is payable to the widow
or widower and, | ||||||
8 | if there be no widow or widower, then to such
dependents, | ||||||
9 | in the proportion which such dependency bears to total
| ||||||
10 | dependency.
| ||||||
11 | Beginning July 1, 1980, and every 6 months thereafter, the | ||||||
12 | Commission
shall examine the Second Injury Fund and when, after | ||||||
13 | deducting all
advances or loans made to such Fund, the amount | ||||||
14 | therein is $500,000
then the amount required to be paid by | ||||||
15 | employers pursuant to paragraph
(f) of Section 7 shall be | ||||||
16 | reduced by one-half. When the Second Injury Fund
reaches the | ||||||
17 | sum of $600,000 then the payments shall cease entirely.
| ||||||
18 | However, when the Second Injury Fund has been reduced to | ||||||
19 | $400,000, payment
of one-half of the amounts required by | ||||||
20 | paragraph (f) of Section 7
shall be resumed, in the manner | ||||||
21 | herein provided, and when the Second Injury
Fund has been | ||||||
22 | reduced to $300,000, payment of the full amounts required by
| ||||||
23 | paragraph (f) of Section 7 shall be resumed, in the manner | ||||||
24 | herein provided.
The Commission shall make the changes in | ||||||
25 | payment effective by
general order, and the changes in payment | ||||||
26 | become immediately effective
for all cases coming before the |
| |||||||
| |||||||
1 | Commission thereafter either by
settlement agreement or final | ||||||
2 | order, irrespective of the date of the
accidental injury.
| ||||||
3 | On August 1, 1996 and on February 1 and August 1 of each | ||||||
4 | subsequent year, the Commission
shall examine the special fund | ||||||
5 | designated as the "Rate
Adjustment Fund" and when, after | ||||||
6 | deducting all advances or loans made to
said fund, the amount | ||||||
7 | therein is $4,000,000, the amount required to be
paid by | ||||||
8 | employers pursuant to paragraph (f) of Section 7 shall be
| ||||||
9 | reduced by one-half. When the Rate Adjustment Fund reaches the | ||||||
10 | sum of
$5,000,000 the payment therein shall cease entirely. | ||||||
11 | However, when said
Rate Adjustment Fund has been reduced to | ||||||
12 | $3,000,000 the amounts required by
paragraph (f) of Section 7 | ||||||
13 | shall be resumed in the manner herein provided.
| ||||||
14 | (f) In case of complete disability, which renders the | ||||||
15 | employee
wholly and permanently incapable of work, or in the | ||||||
16 | specific case of
total and permanent disability as provided in | ||||||
17 | subparagraph 18 of
paragraph (e) of this Section, compensation | ||||||
18 | shall be payable at the rate
provided in subparagraph 2 of | ||||||
19 | paragraph (b) of this Section for life.
| ||||||
20 | An employee entitled to benefits under paragraph (f) of | ||||||
21 | this Section
shall also be entitled to receive from the Rate | ||||||
22 | Adjustment
Fund provided in paragraph (f) of Section 7 of the | ||||||
23 | supplementary benefits
provided in paragraph (g) of this | ||||||
24 | Section 8.
| ||||||
25 | If any employee who receives an award under this paragraph | ||||||
26 | afterwards
returns to work or is able to do so, and earns or is |
| |||||||
| |||||||
1 | able to earn as
much as before the accident, payments under | ||||||
2 | such award shall cease. If
such employee returns to work, or is | ||||||
3 | able to do so, and earns or is able
to earn part but not as much | ||||||
4 | as before the accident, such award shall be
modified so as to | ||||||
5 | conform to an award under paragraph (d) of this
Section. If | ||||||
6 | such award is terminated or reduced under the provisions of
| ||||||
7 | this paragraph, such employees have the right at any time | ||||||
8 | within 30
months after the date of such termination or | ||||||
9 | reduction to file petition
with the Commission for the purpose | ||||||
10 | of determining whether any
disability exists as a result of the | ||||||
11 | original accidental injury and the
extent thereof.
| ||||||
12 | Disability as enumerated in subdivision 18, paragraph (e) | ||||||
13 | of this
Section is considered complete disability.
| ||||||
14 | If an employee who had previously incurred loss or the | ||||||
15 | permanent and
complete loss of use of one member, through the | ||||||
16 | loss or the permanent
and complete loss of the use of one hand, | ||||||
17 | one arm, one foot, one leg, or
one eye, incurs permanent and | ||||||
18 | complete disability through the loss or
the permanent and | ||||||
19 | complete loss of the use of another member, he shall
receive, | ||||||
20 | in addition to the compensation payable by the employer and
| ||||||
21 | after such payments have ceased, an amount from the Second | ||||||
22 | Injury Fund
provided for in paragraph (f) of Section 7, which, | ||||||
23 | together with the
compensation payable from the employer in | ||||||
24 | whose employ he was when the
last accidental injury was | ||||||
25 | incurred, will equal the amount payable for
permanent and | ||||||
26 | complete disability as provided in this paragraph of this
|
| |||||||
| |||||||
1 | Section.
| ||||||
2 | The custodian of the Second Injury Fund provided for in | ||||||
3 | paragraph (f)
of Section 7 shall be joined with the employer as | ||||||
4 | a party respondent in
the application for adjustment of claim. | ||||||
5 | The application for adjustment
of claim shall state briefly and | ||||||
6 | in general terms the approximate time
and place and manner of | ||||||
7 | the loss of the first member.
| ||||||
8 | In its award the Commission or the Arbitrator shall | ||||||
9 | specifically find
the amount the injured employee shall be | ||||||
10 | weekly paid, the number of
weeks compensation which shall be | ||||||
11 | paid by the employer, the date upon
which payments begin out of | ||||||
12 | the Second Injury Fund provided for in
paragraph (f) of Section | ||||||
13 | 7 of this Act, the length of time the weekly
payments continue, | ||||||
14 | the date upon which the pension payments commence and
the | ||||||
15 | monthly amount of the payments. The Commission shall 30 days | ||||||
16 | after
the date upon which payments out of the Second Injury | ||||||
17 | Fund have begun as
provided in the award, and every month | ||||||
18 | thereafter, prepare and submit to
the State Comptroller a | ||||||
19 | voucher for payment for all compensation accrued
to that date | ||||||
20 | at the rate fixed by the Commission. The State Comptroller
| ||||||
21 | shall draw a warrant to the injured employee along with a | ||||||
22 | receipt to be
executed by the injured employee and returned to | ||||||
23 | the Commission. The
endorsed warrant and receipt is a full and | ||||||
24 | complete acquittance to the
Commission for the payment out of | ||||||
25 | the Second Injury Fund. No other
appropriation or warrant is | ||||||
26 | necessary for payment out of the Second
Injury Fund. The Second |
| |||||||
| |||||||
1 | Injury Fund is appropriated for the purpose of
making payments | ||||||
2 | according to the terms of the awards.
| ||||||
3 | As of July 1, 1980 to July 1, 1982, all claims against and | ||||||
4 | obligations
of the Second Injury Fund shall become claims | ||||||
5 | against and obligations of
the Rate Adjustment Fund to the | ||||||
6 | extent there is insufficient money in the
Second Injury Fund to | ||||||
7 | pay such claims and obligations. In that case, all
references | ||||||
8 | to "Second Injury Fund" in this Section shall also include the
| ||||||
9 | Rate Adjustment Fund.
| ||||||
10 | (g) Every award for permanent total disability entered by | ||||||
11 | the
Commission on and after July 1, 1965 under which | ||||||
12 | compensation payments
shall become due and payable after the | ||||||
13 | effective date of this amendatory
Act, and every award for | ||||||
14 | death benefits or permanent total disability
entered by the | ||||||
15 | Commission on and after the effective date of this
amendatory | ||||||
16 | Act shall be subject to annual adjustments as to the amount
of | ||||||
17 | the compensation rate therein provided. Such adjustments shall | ||||||
18 | first
be made on July 15, 1977, and all awards made and entered | ||||||
19 | prior to July
1, 1975 and on July 15 of each year
thereafter. | ||||||
20 | In all other cases such adjustment shall be made on July 15
of | ||||||
21 | the second year next following the date of the entry of the | ||||||
22 | award and
shall further be made on July 15 annually thereafter. | ||||||
23 | If during the
intervening period from the date of the entry of | ||||||
24 | the award, or the last
periodic adjustment, there shall have | ||||||
25 | been an increase in the State's
average weekly wage in covered | ||||||
26 | industries under the Unemployment
Insurance Act, the weekly |
| |||||||
| |||||||
1 | compensation rate shall be proportionately
increased by the | ||||||
2 | same percentage as the percentage of increase in the
State's | ||||||
3 | average weekly wage in covered industries under the
| ||||||
4 | Unemployment Insurance Act. The increase in the compensation | ||||||
5 | rate
under this paragraph shall in no event bring the total | ||||||
6 | compensation rate
to an amount greater than the prevailing | ||||||
7 | maximum rate at the time that the annual adjustment is made. | ||||||
8 | Such increase
shall be paid in the same manner as herein | ||||||
9 | provided for payments under
the Second Injury Fund to the | ||||||
10 | injured employee, or his dependents, as
the case may be, out of | ||||||
11 | the Rate Adjustment Fund provided
in paragraph (f) of Section 7 | ||||||
12 | of this Act. Payments shall be made at
the same intervals as | ||||||
13 | provided in the award or, at the option of the
Commission, may | ||||||
14 | be made in quarterly payment on the 15th day of January,
April, | ||||||
15 | July and October of each year. In the event of a decrease in
| ||||||
16 | such average weekly wage there shall be no change in the then | ||||||
17 | existing
compensation rate. The within paragraph shall not | ||||||
18 | apply to cases where
there is disputed liability and in which a | ||||||
19 | compromise lump sum settlement
between the employer and the | ||||||
20 | injured employee, or his dependents, as the
case may be, has | ||||||
21 | been duly approved by the Illinois Workers' Compensation
| ||||||
22 | Commission.
| ||||||
23 | Provided, that in cases of awards entered by the Commission | ||||||
24 | for
injuries occurring before July 1, 1975, the increases in | ||||||
25 | the
compensation rate adjusted under the foregoing provision of | ||||||
26 | this
paragraph (g) shall be limited to increases in the State's |
| |||||||
| |||||||
1 | average
weekly wage in covered industries under the | ||||||
2 | Unemployment Insurance Act
occurring after July 1, 1975.
| ||||||
3 | For every accident occurring on or after July 20, 2005 but | ||||||
4 | before the effective date of this amendatory Act of the 94th | ||||||
5 | General Assembly (Senate Bill 1283 of the 94th General | ||||||
6 | Assembly), the annual adjustments to the compensation rate in | ||||||
7 | awards for death benefits or permanent total disability, as | ||||||
8 | provided in this Act, shall be paid by the employer. The | ||||||
9 | adjustment shall be made by the employer on July 15 of the | ||||||
10 | second year next following the date of the entry of the award | ||||||
11 | and shall further be made on July 15 annually thereafter. If | ||||||
12 | during the intervening period from the date of the entry of the | ||||||
13 | award, or the last periodic adjustment, there shall have been | ||||||
14 | an increase in the State's average weekly wage in covered | ||||||
15 | industries under the Unemployment Insurance Act, the employer | ||||||
16 | shall increase the weekly compensation rate proportionately by | ||||||
17 | the same percentage as the percentage of increase in the | ||||||
18 | State's average weekly wage in covered industries under the | ||||||
19 | Unemployment Insurance Act. The increase in the compensation | ||||||
20 | rate under this paragraph shall in no event bring the total | ||||||
21 | compensation rate to an amount greater than the prevailing | ||||||
22 | maximum rate at the time that the annual adjustment is made. In | ||||||
23 | the event of a decrease in such average weekly wage there shall | ||||||
24 | be no change in the then existing compensation rate. Such | ||||||
25 | increase shall be paid by the employer in the same manner and | ||||||
26 | at the same intervals as the payment of compensation in the |
| |||||||
| |||||||
1 | award. This paragraph shall not apply to cases where there is | ||||||
2 | disputed liability and in which a compromise lump sum | ||||||
3 | settlement between the employer and the injured employee, or | ||||||
4 | his or her dependents, as the case may be, has been duly | ||||||
5 | approved by the Illinois Workers' Compensation Commission. | ||||||
6 | The annual adjustments for every award of death benefits or | ||||||
7 | permanent total disability involving accidents occurring | ||||||
8 | before July 20, 2005 and accidents occurring on or after the | ||||||
9 | effective date of this amendatory Act of the 94th General | ||||||
10 | Assembly (Senate Bill 1283 of the 94th General Assembly) shall | ||||||
11 | continue to be paid from the Rate Adjustment Fund pursuant to | ||||||
12 | this paragraph and Section 7(f) of this Act.
| ||||||
13 | (h) In case death occurs from any cause before the total
| ||||||
14 | compensation to which the employee would have been entitled has | ||||||
15 | been
paid, then in case the employee leaves any widow, widower, | ||||||
16 | child, parent
(or any grandchild, grandparent or other lineal | ||||||
17 | heir or any collateral
heir dependent at the time of the | ||||||
18 | accident upon the earnings of the
employee to the extent of 50% | ||||||
19 | or more of total dependency) such
compensation shall be paid to | ||||||
20 | the beneficiaries of the deceased employee
and distributed as | ||||||
21 | provided in paragraph (g) of Section 7.
| ||||||
22 | (h-1) In case an injured employee is under legal disability
| ||||||
23 | at the time when any right or privilege accrues to him or her | ||||||
24 | under this
Act, a guardian may be appointed pursuant to law, | ||||||
25 | and may, on behalf
of such person under legal disability, claim | ||||||
26 | and exercise any
such right or privilege with the same effect |
| |||||||
| |||||||
1 | as if the employee himself
or herself had claimed or exercised | ||||||
2 | the right or privilege. No limitations
of time provided by this | ||||||
3 | Act run so long as the employee who is under legal
disability | ||||||
4 | is without a conservator or guardian.
| ||||||
5 | (i) In case the injured employee is under 16 years of age | ||||||
6 | at the
time of the accident and is illegally employed, the | ||||||
7 | amount of
compensation payable under paragraphs (b), (c), (d), | ||||||
8 | (e) and (f) of this
Section is increased 50%.
| ||||||
9 | However, where an employer has on file an employment | ||||||
10 | certificate
issued pursuant to the Child Labor Law or work | ||||||
11 | permit issued pursuant
to the Federal Fair Labor Standards Act, | ||||||
12 | as amended, or a birth
certificate properly and duly issued, | ||||||
13 | such certificate, permit or birth
certificate is conclusive | ||||||
14 | evidence as to the age of the injured minor
employee for the | ||||||
15 | purposes of this Section.
| ||||||
16 | Nothing herein contained repeals or amends the provisions | ||||||
17 | of the
Child Labor Law relating to the employment of minors | ||||||
18 | under the age of 16 years.
| ||||||
19 | (j) 1. In the event the injured employee receives benefits,
| ||||||
20 | including medical, surgical or hospital benefits under any | ||||||
21 | group plan
covering non-occupational disabilities contributed | ||||||
22 | to wholly or
partially by the employer, which benefits should | ||||||
23 | not have been payable
if any rights of recovery existed under | ||||||
24 | this Act, then such amounts so
paid to the employee from any | ||||||
25 | such group plan as shall be consistent
with, and limited to, | ||||||
26 | the provisions of paragraph 2 hereof, shall be
credited to or |
| |||||||
| |||||||
1 | against any compensation payment for temporary total
| ||||||
2 | incapacity for work or any medical, surgical or hospital | ||||||
3 | benefits made
or to be made under this Act. In such event, the | ||||||
4 | period of time for
giving notice of accidental injury and | ||||||
5 | filing application for adjustment
of claim does not commence to | ||||||
6 | run until the termination of such
payments. This paragraph does | ||||||
7 | not apply to payments made under any
group plan which would | ||||||
8 | have been payable irrespective of an accidental
injury under | ||||||
9 | this Act. Any employer receiving such credit shall keep
such | ||||||
10 | employee safe and harmless from any and all claims or | ||||||
11 | liabilities
that may be made against him by reason of having | ||||||
12 | received such payments
only to the extent of such credit.
| ||||||
13 | Any excess benefits paid to or on behalf of a State | ||||||
14 | employee by the
State Employees' Retirement System under | ||||||
15 | Article 14 of the Illinois Pension
Code on a death claim or | ||||||
16 | disputed disability claim shall be credited
against any | ||||||
17 | payments made or to be made by the State of Illinois to or on
| ||||||
18 | behalf of such employee under this Act, except for payments for | ||||||
19 | medical
expenses which have already been incurred at the time | ||||||
20 | of the award. The
State of Illinois shall directly reimburse | ||||||
21 | the State Employees' Retirement
System to the extent of such | ||||||
22 | credit.
| ||||||
23 | 2. Nothing contained in this Act shall be construed to give | ||||||
24 | the
employer or the insurance carrier the right to credit for | ||||||
25 | any benefits
or payments received by the employee other than | ||||||
26 | compensation payments
provided by this Act, and where the |
| |||||||
| |||||||
1 | employee receives payments other
than compensation payments, | ||||||
2 | whether as full or partial salary, group
insurance benefits, | ||||||
3 | bonuses, annuities or any other payments, the
employer or | ||||||
4 | insurance carrier shall receive credit for each such payment
| ||||||
5 | only to the extent of the compensation that would have been | ||||||
6 | payable
during the period covered by such payment.
| ||||||
7 | 3. The extension of time for the filing of an Application | ||||||
8 | for
Adjustment of Claim as provided in paragraph 1 above shall | ||||||
9 | not apply to
those cases where the time for such filing had | ||||||
10 | expired prior to the date
on which payments or benefits | ||||||
11 | enumerated herein have been initiated or
resumed. Provided | ||||||
12 | however that this paragraph 3 shall apply only to
cases wherein | ||||||
13 | the payments or benefits hereinabove enumerated shall be
| ||||||
14 | received after July 1, 1969.
| ||||||
15 | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05; | ||||||
16 | 94-695, eff. 11-16-05.)
| ||||||
17 | (820 ILCS 305/8.1a new) | ||||||
18 | Sec. 8.1a. Preferred provider programs. Starting on the | ||||||
19 | effective date of this amendatory Act of the 97th General | ||||||
20 | Assembly, to satisfy its liabilities under this Act for the | ||||||
21 | provision of medical treatment to injured employees, an | ||||||
22 | employer may utilize a preferred provider program approved by | ||||||
23 | the Illinois Department of Insurance as in compliance with | ||||||
24 | Sections 370k, 370l, 370m, and 370p of Article XX-1/2 of the | ||||||
25 | Illinois Insurance Code. For the purposes of compliance with |
| |||||||
| |||||||
1 | these Sections, the employee shall be considered the | ||||||
2 | "beneficiary" and the employer shall be considered the | ||||||
3 | "insured". Employers and insurers contracting directly with | ||||||
4 | providers or utilizing multiple preferred provider programs to | ||||||
5 | implement a preferred provider program providing workers' | ||||||
6 | compensation benefits shall be subject to the above | ||||||
7 | requirements of Article XX-1/2 applicable to administrators | ||||||
8 | with regard to such program, with the exception of Section 370l | ||||||
9 | of the Illinois Insurance Code. | ||||||
10 | (a) In addition to the above requirements of Article XX-1/2 | ||||||
11 | of the Illinois Insurance Code, all preferred provider programs | ||||||
12 | under this Section shall meet the following requirements: | ||||||
13 | (1) The provider network shall include an adequate | ||||||
14 | number of occupational and non-occupational providers. | ||||||
15 | (2) The provider network shall include an adequate | ||||||
16 | number and type of physicians or other providers to treat | ||||||
17 | common injuries experienced by injured workers in the | ||||||
18 | geographic area where the employees reside. | ||||||
19 | (3) Medical treatment for injuries shall be readily | ||||||
20 | available at reasonable times to all employees. To the | ||||||
21 | extent feasible, all medical treatment for injuries shall | ||||||
22 | be readily accessible to all employees. | ||||||
23 | (4) Physician compensation shall not be structured in | ||||||
24 | order to achieve the goal of inappropriately reducing, | ||||||
25 | delaying, or denying medical treatment or restricting | ||||||
26 | access to medical treatment. |
| |||||||
| |||||||
1 | (5) Before entering into any agreement under this | ||||||
2 | Section, a program shall establish terms and conditions | ||||||
3 | that must be met by noninstitutional providers wishing to | ||||||
4 | enter into an agreement with the program. These terms and | ||||||
5 | conditions may not discriminate unreasonably against or | ||||||
6 | among noninstitutional providers. Neither difference in | ||||||
7 | prices among noninstitutional providers produced by a | ||||||
8 | process of individual negotiation nor price differences | ||||||
9 | among other noninstitutional providers in different | ||||||
10 | geographical areas or different specialties constitutes | ||||||
11 | unreasonable discrimination. | ||||||
12 | (b) The administrator of any preferred provider program | ||||||
13 | under this Act that uses economic evaluation shall file with | ||||||
14 | the Director of Insurance a description of any policies and | ||||||
15 | procedures related to economic evaluation utilized by the | ||||||
16 | program. The filing shall describe how these policies and | ||||||
17 | procedures are used in utilization review, peer review, | ||||||
18 | incentive and penalty programs, and in provider retention and | ||||||
19 | termination decisions. The Director of Insurance may deny | ||||||
20 | approval of any preferred provider program that uses any policy | ||||||
21 | or procedure of economic evaluation to inappropriately reduce, | ||||||
22 | delay or deny medical treatment, or to restrict access to | ||||||
23 | medical treatment. Evaluation of providers based upon | ||||||
24 | objective medical quality and patient outcome measurements, | ||||||
25 | appropriate use of best clinical practices and evidence based | ||||||
26 | medicine, and use of health information technology shall be |
| |||||||
| |||||||
1 | permitted. If approved, the employer shall provide a copy of | ||||||
2 | the filing to all participating providers. | ||||||
3 | (1) The Director of the Department of Insurance shall | ||||||
4 | make each administrator's filing available to the public | ||||||
5 | upon request. The Director of the Department of Insurance | ||||||
6 | may not publicly disclose any information submitted | ||||||
7 | pursuant to this Section that is determined by the Director | ||||||
8 | of the Department of Insurance to be confidential, | ||||||
9 | proprietary, or trade secret information pursuant to State | ||||||
10 | or federal law. | ||||||
11 | (2) For the purposes of this subsection (b), "economic | ||||||
12 | evaluation" shall mean any evaluation of a particular | ||||||
13 | physician, provider, medical group, or individual practice | ||||||
14 | association based in whole or in part on the economic costs | ||||||
15 | or utilization of services associated with medical care | ||||||
16 | provided or authorized by the physician, provider, medical | ||||||
17 | group, or individual practice association. Economic | ||||||
18 | evaluation shall not include negotiated rates with a | ||||||
19 | provider. | ||||||
20 | (c) Except for the provisions of subsection (a)(4) of | ||||||
21 | Section 8 and for injuries occurring on or after the effective | ||||||
22 | date of this amendatory Act of the 97th General Assembly, an | ||||||
23 | employee of an employer utilizing a preferred provider program | ||||||
24 | shall only be allowed to select a participating network | ||||||
25 | provider from the network. An employer shall be responsible | ||||||
26 | for: (i) all first aid and emergency treatment; (ii) all |
| |||||||
| |||||||
1 | medical, surgical, and hospital services provided by the | ||||||
2 | participating network provider initially selected by the | ||||||
3 | employee or by any other participating network provider | ||||||
4 | recommended by the initial participating network provider or | ||||||
5 | any subsequent participating network provider in the chain of | ||||||
6 | referrals from the initial participating network provider; and | ||||||
7 | (iii) all medical, surgical, and hospital services provided by | ||||||
8 | the participating network provider subsequently chosen by the | ||||||
9 | employee or by any other participating network provider | ||||||
10 | recommended by the subsequent participating network provider | ||||||
11 | or any subsequent participating network provider in the chain | ||||||
12 | of referrals from the second participating network provider. An | ||||||
13 | employer shall not be liable for services determined by the | ||||||
14 | Commission not to be compensable. An employer shall not be | ||||||
15 | liable for medical services provided by a non-authorized | ||||||
16 | provider when proper notice is provided to the injured worker. | ||||||
17 | (1) When the injured employee notifies the employer of | ||||||
18 | the injury or files a claim for workers' compensation with | ||||||
19 | the employer, the employer shall notify the employee of his | ||||||
20 | or her right to be treated by a physician of his or her | ||||||
21 | choice from the preferred provider network established | ||||||
22 | pursuant to this Section, and the method by which the list | ||||||
23 | of participating network providers may be accessed by the | ||||||
24 | employee, except as provided in subsection (a)(4) of | ||||||
25 | Section 8. | ||||||
26 | (2) Consistent with Article XX-1/2 of the Illinois |
| |||||||
| |||||||
1 | Insurance Code, treatment by a specialist who is not a | ||||||
2 | member of the preferred provider network shall be permitted | ||||||
3 | on a case-by-case basis if the medical provider network | ||||||
4 | does not contain a physician who can provide the approved | ||||||
5 | treatment, and if the employee has complied with any | ||||||
6 | pre-authorization requirements of the preferred provider | ||||||
7 | network. Consent for the employee to visit an | ||||||
8 | out-of-network provider may not be unreasonably withheld. | ||||||
9 | When a non-network provider is authorized pursuant to this | ||||||
10 | subparagraph (2), the non-network provider shall not hold | ||||||
11 | an employee liable for costs except as provided in | ||||||
12 | subsection (e) of Section 8.2. | ||||||
13 | (3) The Director shall not approve, and may withdraw | ||||||
14 | prior approval of, a preferred provider program that fails | ||||||
15 | to provide an injured employee with sufficient access to | ||||||
16 | necessary treating physicians, surgeons, and specialists. | ||||||
17 | (d) Except as provided in subsection (a)(4) of Section 8, | ||||||
18 | upon a finding by the Commission that the care being rendered | ||||||
19 | by the employee's second choice of provider within the | ||||||
20 | employer's network is improper or inadequate, the employee may | ||||||
21 | then choose a provider outside of the network at the employer's | ||||||
22 | expense. The Commission shall issue a decision on any petition | ||||||
23 | filed pursuant to this Section within 5 working days. | ||||||
24 | (e) The Director of the Department of Insurance may | ||||||
25 | promulgate such rules as are necessary to carry out the | ||||||
26 | provisions of this Section relating to approval and regulation |
| |||||||
| |||||||
1 | of preferred provider programs.
| ||||||
2 | (820 ILCS 305/8.1b new) | ||||||
3 | Sec. 8.1b. Determination of permanent partial disability. | ||||||
4 | For accidental injuries that occur on or after September 1, | ||||||
5 | 2011, permanent partial disability shall be established using | ||||||
6 | the following criteria: | ||||||
7 | (a) A physician licensed to practice medicine in all of its | ||||||
8 | branches preparing a permanent partial disability impairment | ||||||
9 | report shall report the level of impairment in writing. The | ||||||
10 | report shall include an evaluation of medically defined and | ||||||
11 | professionally appropriate measurements of impairment that | ||||||
12 | include, but are not limited to: loss of range of motion; loss | ||||||
13 | of strength; measured atrophy of tissue mass consistent with | ||||||
14 | the injury; and any other measurements that establish the | ||||||
15 | nature and extent of the impairment. The most current edition | ||||||
16 | of the American Medical Association's "Guides to the Evaluation | ||||||
17 | of Permanent Impairment" shall be used by the physician in | ||||||
18 | determining the level of impairment. | ||||||
19 | (b) In determining the level of permanent partial | ||||||
20 | disability, the Commission shall base its determination on the | ||||||
21 | following factors: (i) the reported level of impairment | ||||||
22 | pursuant to subsection (a); (ii) the occupation of the injured | ||||||
23 | employee; (iii) the age of the employee at the time of the | ||||||
24 | injury; (iv) the employee's future earning capacity; and (v) | ||||||
25 | evidence of disability corroborated by the treating medical |
| |||||||
| |||||||
1 | records. No single enumerated factor shall be the sole | ||||||
2 | determinant of disability. In determining the level of | ||||||
3 | disability, the relevance and weight of any factors used in | ||||||
4 | addition to the level of impairment as reported by the | ||||||
5 | physician must be explained in a written order.
| ||||||
6 | (820 ILCS 305/8.2)
| ||||||
7 | Sec. 8.2. Fee schedule.
| ||||||
8 | (a) Except as provided for in subsection (c), for | ||||||
9 | procedures, treatments, or services covered under this Act and | ||||||
10 | rendered or to be rendered on and after February 1, 2006, the | ||||||
11 | maximum allowable payment shall be 90% of the 80th percentile | ||||||
12 | of charges and fees as determined by the Commission utilizing | ||||||
13 | information provided by employers' and insurers' national | ||||||
14 | databases, with a minimum of 12,000,000 Illinois line item | ||||||
15 | charges and fees comprised of health care provider and hospital | ||||||
16 | charges and fees as of August 1, 2004 but not earlier than | ||||||
17 | August 1, 2002. These charges and fees are provider billed | ||||||
18 | amounts and shall not include discounted charges. The 80th | ||||||
19 | percentile is the point on an ordered data set from low to high | ||||||
20 | such that 80% of the cases are below or equal to that point and | ||||||
21 | at most 20% are above or equal to that point. The Commission | ||||||
22 | shall adjust these historical charges and fees as of August 1, | ||||||
23 | 2004 by the Consumer Price Index-U for the period August 1, | ||||||
24 | 2004 through September 30, 2005. The Commission shall establish | ||||||
25 | fee schedules for procedures, treatments, or services for |
| |||||||
| |||||||
1 | hospital inpatient, hospital outpatient, emergency room and | ||||||
2 | trauma, ambulatory surgical treatment centers, and | ||||||
3 | professional services. These charges and fees shall be | ||||||
4 | designated by geozip or any smaller geographic unit. The data | ||||||
5 | shall in no way identify or tend to identify any patient, | ||||||
6 | employer, or health care provider. As used in this Section, | ||||||
7 | "geozip" means a three-digit zip code based on data | ||||||
8 | similarities, geographical similarities, and frequencies. A | ||||||
9 | geozip does not cross state boundaries. As used in this | ||||||
10 | Section, "three-digit zip code" means a geographic area in | ||||||
11 | which all zip codes have the same first 3 digits. If a geozip | ||||||
12 | does not have the necessary number of charges and fees to | ||||||
13 | calculate a valid percentile for a specific procedure, | ||||||
14 | treatment, or service, the Commission may combine data from the | ||||||
15 | geozip with up to 4 other geozips that are demographically and | ||||||
16 | economically similar and exhibit similarities in data and | ||||||
17 | frequencies until the Commission reaches 9 charges or fees for | ||||||
18 | that specific procedure, treatment, or service. In cases where | ||||||
19 | the compiled data contains less than 9 charges or fees for a | ||||||
20 | procedure, treatment, or service, reimbursement shall occur at | ||||||
21 | 76% of charges and fees as determined by the Commission in a | ||||||
22 | manner consistent with the provisions of this paragraph. | ||||||
23 | Providers of out-of-state procedures, treatments, services, | ||||||
24 | products, or supplies shall be reimbursed at the lesser of that | ||||||
25 | state's fee schedule amount or the fee schedule amount for the | ||||||
26 | region in which the employee resides. If no fee schedule exists |
| |||||||
| |||||||
1 | in that state, the provider shall be reimbursed at the lesser | ||||||
2 | of the actual charge or the fee schedule amount for the region | ||||||
3 | in which the employee resides. The Commission has the authority | ||||||
4 | to set the maximum allowable payment to providers of | ||||||
5 | out-of-state procedures, treatments, or services covered under | ||||||
6 | this Act in a manner consistent with this Section. Not later | ||||||
7 | than September 30 in 2006 and each year thereafter, the | ||||||
8 | Commission shall automatically increase or decrease the | ||||||
9 | maximum allowable payment for a procedure, treatment, or | ||||||
10 | service established and in effect on January 1 of that year by | ||||||
11 | the percentage change in the Consumer Price Index-U for the 12 | ||||||
12 | month period ending August 31 of that year. The increase or | ||||||
13 | decrease shall become effective on January 1 of the following | ||||||
14 | year. As used in this Section, "Consumer Price Index-U" means | ||||||
15 | the index published by the Bureau of Labor Statistics of the | ||||||
16 | U.S. Department of Labor, that measures the average change in | ||||||
17 | prices of all goods and services purchased by all urban | ||||||
18 | consumers, U.S. city average, all items, 1982-84=100. | ||||||
19 | (a-1) Notwithstanding the provisions of subsection (a) and | ||||||
20 | unless otherwise indicated, the following provisions shall | ||||||
21 | apply to the medical fee schedule starting on September 1, | ||||||
22 | 2011: | ||||||
23 | (1) The Commission shall establish and maintain fee | ||||||
24 | schedules for procedures, treatments, products, services, | ||||||
25 | or supplies for hospital inpatient, hospital outpatient, | ||||||
26 | emergency room, ambulatory surgical treatment centers, |
| |||||||
| |||||||
1 | accredited ambulatory surgical treatment facilities, | ||||||
2 | prescriptions filled and dispensed outside of a licensed | ||||||
3 | pharmacy, dental services, and professional services. This | ||||||
4 | fee schedule shall be based on the fee schedule amounts | ||||||
5 | already established by the Commission pursuant to | ||||||
6 | subsection (a) of this Section. However, starting on | ||||||
7 | January 1, 2012, these fee schedule amounts shall be | ||||||
8 | grouped into geographic regions in the following manner: | ||||||
9 | (A) Four regions for non-hospital fee schedule | ||||||
10 | amounts shall be utilized: | ||||||
11 | (i) Cook County; | ||||||
12 | (ii) DuPage, Kane, Lake, and Will Counties; | ||||||
13 | (iii) Bond, Calhoun, Clinton, Jersey, | ||||||
14 | Macoupin, Madison, Monroe, Montgomery, Randolph, | ||||||
15 | St. Clair, and Washington Counties; and | ||||||
16 | (iv) All other counties of the State. | ||||||
17 | (B) Fourteen regions for hospital fee schedule | ||||||
18 | amounts shall be utilized: | ||||||
19 | (i) Cook, DuPage, Will, Kane, McHenry, DeKalb, | ||||||
20 | Kendall, and Grundy Counties; | ||||||
21 | (ii) Kankakee County; | ||||||
22 | (iii) Madison, St. Clair, Macoupin, Clinton, | ||||||
23 | Monroe, Jersey, Bond, and Calhoun Counties; | ||||||
24 | (iv) Winnebago and Boone Counties; | ||||||
25 | (v) Peoria, Tazewell, Woodford, Marshall, and | ||||||
26 | Stark Counties; |
| |||||||
| |||||||
1 | (vi) Champaign, Piatt, and Ford Counties; | ||||||
2 | (vii) Rock Island, Henry, and Mercer Counties; | ||||||
3 | (viii) Sangamon and Menard Counties; | ||||||
4 | (ix) McLean County; | ||||||
5 | (x) Lake County; | ||||||
6 | (xi) Macon County; | ||||||
7 | (xii) Vermilion County; | ||||||
8 | (xiii) Alexander County; and | ||||||
9 | (xiv) All other counties of the State. | ||||||
10 | (2) If a geozip, as defined in subsection (a) of this | ||||||
11 | Section, overlaps into one or more of the regions set forth | ||||||
12 | in this Section, then the Commission shall average or | ||||||
13 | repeat the charges and fees in a geozip in order to | ||||||
14 | designate charges and fees for each region. | ||||||
15 | (3) In cases where the compiled data contains less than | ||||||
16 | 9 charges or fees for a procedure, treatment, product, | ||||||
17 | supply, or service or where the fee schedule amount cannot | ||||||
18 | be determined by the non-discounted charge data, | ||||||
19 | non-Medicare relative values and conversion factors | ||||||
20 | derived from established fee schedule amounts, coding | ||||||
21 | crosswalks, or other data as determined by the Commission, | ||||||
22 | reimbursement shall occur at 76% of charges and fees until | ||||||
23 | September 1, 2011 and 53.2% of charges and fees thereafter | ||||||
24 | as determined by the Commission in a manner consistent with | ||||||
25 | the provisions of this paragraph. | ||||||
26 | (4) To establish additional fee schedule amounts, the |
| |||||||
| |||||||
1 | Commission shall utilize provider non-discounted charge | ||||||
2 | data, non-Medicare relative values and conversion factors | ||||||
3 | derived from established fee schedule amounts, and coding | ||||||
4 | crosswalks. The Commission may establish additional fee | ||||||
5 | schedule amounts based on either the charge or cost of the | ||||||
6 | procedure, treatment, product, supply, or service. | ||||||
7 | (5) Implants shall be reimbursed at 25% above the net | ||||||
8 | manufacturer's invoice price less rebates, plus actual | ||||||
9 | reasonable and customary shipping charges whether or not | ||||||
10 | the implant charge is submitted by a provider in | ||||||
11 | conjunction with a bill for all other services associated | ||||||
12 | with the implant, submitted by a provider on a separate | ||||||
13 | claim form, submitted by a distributor, or submitted by the | ||||||
14 | manufacturer of the implant. "Implants" include the | ||||||
15 | following codes or any substantially similar updated code | ||||||
16 | as determined by the Commission: 0274 | ||||||
17 | (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens | ||||||
18 | implant); 0278 (implants); 0540 and 0545 (ambulance); 0624 | ||||||
19 | (investigational devices); and 0636 (drugs requiring | ||||||
20 | detailed coding). Non-implantable devices or supplies | ||||||
21 | within these codes shall be reimbursed at 65% of actual | ||||||
22 | charge, which is the provider's normal rates under its | ||||||
23 | standard chargemaster. A standard chargemaster is the | ||||||
24 | provider's list of charges for procedures, treatments, | ||||||
25 | products, supplies, or services used to bill payers in a | ||||||
26 | consistent manner. |
| |||||||
| |||||||
1 | (6) The Commission shall automatically update all | ||||||
2 | codes and associated rules with the version of the codes | ||||||
3 | and rules valid on January 1 of that year. | ||||||
4 | (a-2) For procedures, treatments, services, or supplies | ||||||
5 | covered under this Act and rendered or to be rendered on or | ||||||
6 | after September 1, 2011, the maximum allowable payment shall be | ||||||
7 | 70% of the fee schedule amounts, which shall be adjusted yearly | ||||||
8 | by the Consumer Price Index-U, as described in subsection (a) | ||||||
9 | of this Section. | ||||||
10 | (a-3) Prescriptions filled and dispensed outside of a | ||||||
11 | licensed pharmacy shall be subject to a fee schedule that shall | ||||||
12 | not exceed the Average Wholesale Price (AWP) plus a dispensing | ||||||
13 | fee of $4.18. AWP or its equivalent as registered by the | ||||||
14 | National Drug Code shall be set forth for that drug on that | ||||||
15 | date as published in Medispan. | ||||||
16 | (b) Notwithstanding the provisions of subsection (a), if
| ||||||
17 | the Commission finds that there is a significant limitation on
| ||||||
18 | access to quality health care in either a specific field of
| ||||||
19 | health care services or a specific geographic limitation on
| ||||||
20 | access to health care, it may change the Consumer Price Index-U
| ||||||
21 | increase or decrease for that specific field or specific
| ||||||
22 | geographic limitation on access to health care to address that
| ||||||
23 | limitation. | ||||||
24 | (c) The Commission shall establish by rule a process to | ||||||
25 | review those medical cases or outliers that involve | ||||||
26 | extra-ordinary treatment to determine whether to make an |
| |||||||
| |||||||
1 | additional adjustment to the maximum payment within a fee | ||||||
2 | schedule for a procedure, treatment, or service. | ||||||
3 | (d) When a patient notifies a provider that the treatment, | ||||||
4 | procedure, or service being sought is for a work-related | ||||||
5 | illness or injury and furnishes the provider the name and | ||||||
6 | address of the responsible employer, the provider shall bill | ||||||
7 | the employer directly. The employer shall make payment and | ||||||
8 | providers shall submit bills and records in accordance with the | ||||||
9 | provisions of this Section. | ||||||
10 | (1) All payments to providers for treatment provided | ||||||
11 | pursuant to this Act shall be made within 30 60 days of | ||||||
12 | receipt of the bills as long as the claim contains | ||||||
13 | substantially all the required data elements necessary to | ||||||
14 | adjudicate the bills. | ||||||
15 | (2) If the claim does not contain substantially all the | ||||||
16 | required data elements necessary to adjudicate the bill, or | ||||||
17 | the claim is denied for any other reason, in whole or in | ||||||
18 | part, the employer or insurer shall provide written | ||||||
19 | notification, explaining the basis for the denial and | ||||||
20 | describing any additional necessary data elements, to the | ||||||
21 | provider within 30 days of receipt of the bill. | ||||||
22 | (3) In the case of nonpayment to a provider within 30 | ||||||
23 | 60 days of receipt of the bill which contained | ||||||
24 | substantially all of the required data elements necessary | ||||||
25 | to adjudicate the bill or nonpayment to a provider of a | ||||||
26 | portion of such a bill up to the lesser of the actual |
| |||||||
| |||||||
1 | charge or the payment level set by the Commission in the | ||||||
2 | fee schedule established in this Section, the bill, or | ||||||
3 | portion of the bill, shall incur interest at a rate of 1% | ||||||
4 | per month payable to the provider. Any required interest | ||||||
5 | payments shall be made within 30 days after payment. | ||||||
6 | (e) Except as provided in subsections (e-5), (e-10), and | ||||||
7 | (e-15), a provider shall not hold an employee liable for costs | ||||||
8 | related to a non-disputed procedure, treatment, or service | ||||||
9 | rendered in connection with a compensable injury. The | ||||||
10 | provisions of subsections (e-5), (e-10), (e-15), and (e-20) | ||||||
11 | shall not apply if an employee provides information to the | ||||||
12 | provider regarding participation in a group health plan. If the | ||||||
13 | employee participates in a group health plan, the provider may | ||||||
14 | submit a claim for services to the group health plan. If the | ||||||
15 | claim for service is covered by the group health plan, the | ||||||
16 | employee's responsibility shall be limited to applicable | ||||||
17 | deductibles, co-payments, or co-insurance. Except as provided | ||||||
18 | under subsections (e-5), (e-10), (e-15), and (e-20), a provider | ||||||
19 | shall not bill or otherwise attempt to recover from the | ||||||
20 | employee the difference between the provider's charge and the | ||||||
21 | amount paid by the employer or the insurer on a compensable | ||||||
22 | injury , or for medical services or treatment determined by the | ||||||
23 | Commission to be excessive or unnecessary . | ||||||
24 | (e-5) If an employer notifies a provider that the employer | ||||||
25 | does not consider the illness or injury to be compensable under | ||||||
26 | this Act, the provider may seek payment of the provider's |
| |||||||
| |||||||
1 | actual charges from the employee for any procedure, treatment, | ||||||
2 | or service rendered. Once an employee informs the provider that | ||||||
3 | there is an application filed with the Commission to resolve a | ||||||
4 | dispute over payment of such charges, the provider shall cease | ||||||
5 | any and all efforts to collect payment for the services that | ||||||
6 | are the subject of the dispute. Any statute of limitations or | ||||||
7 | statute of repose applicable to the provider's efforts to | ||||||
8 | collect payment from the employee shall be tolled from the date | ||||||
9 | that the employee files the application with the Commission | ||||||
10 | until the date that the provider is permitted to resume | ||||||
11 | collection efforts under the provisions of this Section. | ||||||
12 | (e-10) If an employer notifies a provider that the employer | ||||||
13 | will pay only a portion of a bill for any procedure, treatment, | ||||||
14 | or service rendered in connection with a compensable illness or | ||||||
15 | disease, the provider may seek payment from the employee for | ||||||
16 | the remainder of the amount of the bill up to the lesser of the | ||||||
17 | actual charge, negotiated rate, if applicable, or the payment | ||||||
18 | level set by the Commission in the fee schedule established in | ||||||
19 | this Section. Once an employee informs the provider that there | ||||||
20 | is an application filed with the Commission to resolve a | ||||||
21 | dispute over payment of such charges, the provider shall cease | ||||||
22 | any and all efforts to collect payment for the services that | ||||||
23 | are the subject of the dispute. Any statute of limitations or | ||||||
24 | statute of repose applicable to the provider's efforts to | ||||||
25 | collect payment from the employee shall be tolled from the date | ||||||
26 | that the employee files the application with the Commission |
| |||||||
| |||||||
1 | until the date that the provider is permitted to resume | ||||||
2 | collection efforts under the provisions of this Section. | ||||||
3 | (e-15) When there is a dispute over the compensability of | ||||||
4 | or amount of payment for a procedure, treatment, or service, | ||||||
5 | and a case is pending or proceeding before an Arbitrator or the | ||||||
6 | Commission, the provider may mail the employee reminders that | ||||||
7 | the employee will be responsible for payment of any procedure, | ||||||
8 | treatment or service rendered by the provider. The reminders | ||||||
9 | must state that they are not bills, to the extent practicable | ||||||
10 | include itemized information, and state that the employee need | ||||||
11 | not pay until such time as the provider is permitted to resume | ||||||
12 | collection efforts under this Section. The reminders shall not | ||||||
13 | be provided to any credit rating agency. The reminders may | ||||||
14 | request that the employee furnish the provider with information | ||||||
15 | about the proceeding under this Act, such as the file number, | ||||||
16 | names of parties, and status of the case. If an employee fails | ||||||
17 | to respond to such request for information or fails to furnish | ||||||
18 | the information requested within 90 days of the date of the | ||||||
19 | reminder, the provider is entitled to resume any and all | ||||||
20 | efforts to collect payment from the employee for the services | ||||||
21 | rendered to the employee and the employee shall be responsible | ||||||
22 | for payment of any outstanding bills for a procedure, | ||||||
23 | treatment, or service rendered by a provider. | ||||||
24 | (e-20) Upon a final award or judgment by an Arbitrator or | ||||||
25 | the Commission, or a settlement agreed to by the employer and | ||||||
26 | the employee, a provider may resume any and all efforts to |
| |||||||
| |||||||
1 | collect payment from the employee for the services rendered to | ||||||
2 | the employee and the employee shall be responsible for payment | ||||||
3 | of any outstanding bills for a procedure, treatment, or service | ||||||
4 | rendered by a provider as well as the interest awarded under | ||||||
5 | subsection (d) of this Section. In the case of a procedure, | ||||||
6 | treatment, or service deemed compensable, the provider shall | ||||||
7 | not require a payment rate, excluding the interest provisions | ||||||
8 | under subsection (d), greater than the lesser of the actual | ||||||
9 | charge or the payment level set by the Commission in the fee | ||||||
10 | schedule established in this Section. Payment for services | ||||||
11 | deemed not covered or not compensable under this Act is the | ||||||
12 | responsibility of the employee unless a provider and employee | ||||||
13 | have agreed otherwise in writing. Services not covered or not | ||||||
14 | compensable under this Act are not subject to the fee schedule | ||||||
15 | in this Section. | ||||||
16 | (f) Nothing in this Act shall prohibit an employer or
| ||||||
17 | insurer from contracting with a health care provider or group
| ||||||
18 | of health care providers for reimbursement levels for benefits | ||||||
19 | under this Act different
from those provided in this Section. | ||||||
20 | (g) On or before January 1, 2010 the Commission shall | ||||||
21 | provide to the Governor and General Assembly a report regarding | ||||||
22 | the implementation of the medical fee schedule and the index | ||||||
23 | used for annual adjustment to that schedule as described in | ||||||
24 | this Section.
| ||||||
25 | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
|
| |||||||
| |||||||
1 | (820 ILCS 305/8.2a new) | ||||||
2 | Sec. 8.2a. Electronic claims. | ||||||
3 | (a) The Director of Insurance shall adopt rules to do all | ||||||
4 | of the following: | ||||||
5 | (1) Ensure that all health care providers and | ||||||
6 | facilities submit medical bills for payment on | ||||||
7 | standardized forms. | ||||||
8 | (2) Require acceptance by employers and insurers of | ||||||
9 | electronic claims for payment of medical services. | ||||||
10 | (3) Ensure confidentiality of medical information | ||||||
11 | submitted on electronic claims for payment of medical | ||||||
12 | services. | ||||||
13 | (b) To the extent feasible, standards adopted pursuant to | ||||||
14 | subdivision (a) shall be consistent with existing standards | ||||||
15 | under the federal Health Insurance Portability and | ||||||
16 | Accountability Act of 1996 and standards adopted under the | ||||||
17 | Illinois Health Information Exchange and Technology Act. | ||||||
18 | (c) The rules requiring employers and insurers to accept | ||||||
19 | electronic claims for payment of medical services shall be | ||||||
20 | proposed on or before January 1, 2012, and shall require all | ||||||
21 | employers and insurers to accept electronic claims for payment | ||||||
22 | of medical services on or before June 30, 2012. | ||||||
23 | (d) The Director of Insurance shall by rule establish | ||||||
24 | criteria for granting exceptions to employers, insurance | ||||||
25 | carriers, and health care providers who are unable to submit or | ||||||
26 | accept medical bills electronically.
|
| |||||||
| |||||||
1 | (820 ILCS 305/8.7) | ||||||
2 | Sec. 8.7. Utilization review programs. | ||||||
3 | (a) As used in this Section: | ||||||
4 | "Utilization review" means the evaluation of proposed or | ||||||
5 | provided health care services to determine the appropriateness | ||||||
6 | of both the level of health care services medically necessary | ||||||
7 | and the quality of health care services provided to a patient, | ||||||
8 | including evaluation of their efficiency, efficacy, and | ||||||
9 | appropriateness of treatment, hospitalization, or office | ||||||
10 | visits based on medically accepted standards. The evaluation | ||||||
11 | must be accomplished by means of a system that identifies the | ||||||
12 | utilization of health care services based on standards of care | ||||||
13 | of or nationally recognized peer review guidelines as well as | ||||||
14 | nationally recognized treatment guidelines and evidence-based | ||||||
15 | medicine evidence based upon standards as provided in this Act. | ||||||
16 | Utilization techniques may include prospective review, second | ||||||
17 | opinions, concurrent review, discharge planning, peer review, | ||||||
18 | independent medical examinations, and retrospective review | ||||||
19 | (for purposes of this sentence, retrospective review shall be | ||||||
20 | applicable to services rendered on or after July 20, 2005). | ||||||
21 | Nothing in this Section applies to prospective review of | ||||||
22 | necessary first aid or emergency treatment. | ||||||
23 | (b) No person may conduct a utilization review program for | ||||||
24 | workers' compensation services in this State unless once every | ||||||
25 | 2 years the person registers the utilization review program |
| |||||||
| |||||||
1 | with the Department of Insurance Financial and Professional | ||||||
2 | Regulation and certifies compliance with the Workers' | ||||||
3 | Compensation Utilization Management standards or Health | ||||||
4 | Utilization Management Standards of URAC sufficient to achieve | ||||||
5 | URAC accreditation or submits evidence of accreditation by URAC | ||||||
6 | for its Workers' Compensation Utilization Management Standards | ||||||
7 | or Health Utilization Management Standards. Nothing in this Act | ||||||
8 | shall be construed to require an employer or insurer or its | ||||||
9 | subcontractors to become URAC accredited. | ||||||
10 | (c) In addition, the Director Secretary of Insurance | ||||||
11 | Financial and Professional Regulation may certify alternative | ||||||
12 | utilization review standards of national accreditation | ||||||
13 | organizations or entities in order for plans to comply with | ||||||
14 | this Section. Any alternative utilization review standards | ||||||
15 | shall meet or exceed those standards required under subsection | ||||||
16 | (b). | ||||||
17 | (d) This registration shall include submission of all of | ||||||
18 | the following information regarding utilization review program | ||||||
19 | activities: | ||||||
20 | (1) The name, address, and telephone number of the | ||||||
21 | utilization review programs. | ||||||
22 | (2) The organization and governing structure of the | ||||||
23 | utilization review programs. | ||||||
24 | (3) The number of lives for which utilization review is | ||||||
25 | conducted by each utilization review program. | ||||||
26 | (4) Hours of operation of each utilization review |
| |||||||
| |||||||
1 | program. | ||||||
2 | (5) Description of the grievance process for each | ||||||
3 | utilization review program. | ||||||
4 | (6) Number of covered lives for which utilization | ||||||
5 | review was conducted for the previous calendar year for | ||||||
6 | each utilization review program. | ||||||
7 | (7) Written policies and procedures for protecting | ||||||
8 | confidential information according to applicable State and | ||||||
9 | federal laws for each utilization review program. | ||||||
10 | (e) A utilization review program shall have written | ||||||
11 | procedures to ensure that patient-specific information | ||||||
12 | obtained during the process of utilization review will be: | ||||||
13 | (1) kept confidential in accordance with applicable | ||||||
14 | State and federal laws; and | ||||||
15 | (2) shared only with the employee, the employee's | ||||||
16 | designee, and the employee's health care provider, and | ||||||
17 | those who are authorized by law to receive the information. | ||||||
18 | Summary data shall not be considered confidential if it | ||||||
19 | does not provide information to allow identification of | ||||||
20 | individual patients or health care providers. | ||||||
21 | Only a health care professional may make determinations | ||||||
22 | regarding the medical necessity of health care services during | ||||||
23 | the course of utilization review. | ||||||
24 | When making retrospective reviews, utilization review | ||||||
25 | programs shall base reviews solely on the medical information | ||||||
26 | available to the attending physician or ordering provider at |
| |||||||
| |||||||
1 | the time the health care services were provided. | ||||||
2 | (f) If the Department of Insurance Financial and | ||||||
3 | Professional Regulation finds that a utilization review | ||||||
4 | program is not in compliance with this Section, the Department | ||||||
5 | shall issue a corrective action plan and allow a reasonable | ||||||
6 | amount of time for compliance with the plan. If the utilization | ||||||
7 | review program does not come into compliance, the Department | ||||||
8 | may issue a cease and desist order. Before issuing a cease and | ||||||
9 | desist order under this Section, the Department shall provide | ||||||
10 | the utilization review program with a written notice of the | ||||||
11 | reasons for the order and allow a reasonable amount of time to | ||||||
12 | supply additional information demonstrating compliance with | ||||||
13 | the requirements of this Section and to request a hearing. The | ||||||
14 | hearing notice shall be sent by certified mail, return receipt | ||||||
15 | requested, and the hearing shall be conducted in accordance | ||||||
16 | with the Illinois Administrative Procedure Act. | ||||||
17 | (g) A utilization review program subject to a corrective | ||||||
18 | action may continue to conduct business until a final decision | ||||||
19 | has been issued by the Department. | ||||||
20 | (h) The Department of Insurance Secretary of Financial and | ||||||
21 | Professional Regulation may by rule establish a registration | ||||||
22 | fee for each person conducting a utilization review program. | ||||||
23 | (i) Upon receipt of written notice that the employer or the | ||||||
24 | employer's agent or insurer wishes to invoke the utilization | ||||||
25 | review process, the provider of medical, surgical, or hospital | ||||||
26 | services shall submit to the utilization review, following |
| |||||||
| |||||||
1 | accredited procedural guidelines. | ||||||
2 | (1) The provider shall make reasonable efforts to | ||||||
3 | provide timely and complete reports of clinical | ||||||
4 | information needed to support a request for treatment. If | ||||||
5 | the provider fails to make such reasonable efforts, the | ||||||
6 | charges for the treatment or service may not be compensable | ||||||
7 | nor collectible by the provider or claimant from the | ||||||
8 | employer, the employer's agent, or the employee. The | ||||||
9 | reporting obligations of providers shall not be | ||||||
10 | unreasonable or unduly burdensome. | ||||||
11 | (2) Written notice of utilization review decisions, | ||||||
12 | including the clinical rationale for certification or | ||||||
13 | non-certification and references to applicable standards | ||||||
14 | of care or evidence-based medical guidelines, shall be | ||||||
15 | furnished to the provider and employee. | ||||||
16 | (3) An employer may only deny payment of or refuse to | ||||||
17 | authorize payment of medical services rendered or proposed | ||||||
18 | to be rendered on the grounds that the extent and scope of | ||||||
19 | medical treatment is excessive and unnecessary in | ||||||
20 | compliance with an accredited utilization review program | ||||||
21 | under this Section. | ||||||
22 | (4) When a payment for medical services has been denied | ||||||
23 | or not authorized by an employer or when authorization for | ||||||
24 | medical services is denied pursuant to utilization review, | ||||||
25 | the employee has the burden of proof to show by a | ||||||
26 | preponderance of the evidence that a variance from the |
| |||||||
| |||||||
1 | standards of care used by the person or entity performing | ||||||
2 | the utilization review pursuant to subsection (a) is | ||||||
3 | reasonably required to cure or relieve the effects of his | ||||||
4 | or her injury. | ||||||
5 | (5) The medical professional responsible for review in | ||||||
6 | the final stage of utilization review or appeal must be | ||||||
7 | available in this State for interview or deposition; or | ||||||
8 | must be available for deposition by telephone, video | ||||||
9 | conference, or other remote electronic means. A medical | ||||||
10 | professional who works or resides in this State or outside | ||||||
11 | of this State may comply with this requirement by making | ||||||
12 | himself or herself available for an interview or deposition | ||||||
13 | in person or by making himself or herself available by | ||||||
14 | telephone, video conference, or other remote electronic | ||||||
15 | means. The remote interview or deposition shall be | ||||||
16 | conducted in a fair, open, and cost-effective manner. The | ||||||
17 | expense of interview and the deposition method shall be | ||||||
18 | paid by the employer. The deponent shall be in the presence | ||||||
19 | of the officer administering the oath and recording the | ||||||
20 | deposition, unless otherwise agreed by the parties. Any | ||||||
21 | exhibits or other demonstrative evidence to be presented to | ||||||
22 | the deponent by any party at the deposition shall be | ||||||
23 | provided to the officer administering the oath and all | ||||||
24 | other parties within a reasonable period of time prior to | ||||||
25 | the deposition. Nothing shall prohibit any party from being | ||||||
26 | with the deponent during the deposition, at that party's |
| |||||||
| |||||||
1 | expense; provided, however, that a party attending a | ||||||
2 | deposition shall give written notice of that party's | ||||||
3 | intention to appear at the deposition to all other parties | ||||||
4 | within a reasonable time prior to the deposition. | ||||||
5 | An admissible A utilization review shall will be considered | ||||||
6 | by the Commission, along with all other evidence and in the | ||||||
7 | same manner as all other evidence, and must be addressed along | ||||||
8 | with all other evidence in the determination of the | ||||||
9 | reasonableness and necessity of the medical bills or treatment. | ||||||
10 | Nothing in this Section shall be construed to diminish the | ||||||
11 | rights of employees to reasonable and necessary medical | ||||||
12 | treatment or employee choice of health care provider under | ||||||
13 | Section 8(a) or the rights of employers to medical examinations | ||||||
14 | under Section 12. | ||||||
15 | (j) When an employer denies payment of or refuses to | ||||||
16 | authorize payment of first aid, medical, surgical, or hospital | ||||||
17 | services under Section 8(a) of this Act, if that denial or | ||||||
18 | refusal to authorize complies with a utilization review program | ||||||
19 | registered under this Section and complies with all other | ||||||
20 | requirements of this Section, then there shall be a rebuttable | ||||||
21 | presumption that the employer shall not be responsible for | ||||||
22 | payment of additional compensation pursuant to Section 19(k) of | ||||||
23 | this Act and if that denial or refusal to authorize does not | ||||||
24 | comply with a utilization review program registered under this | ||||||
25 | Section and does not comply with all other requirements of this | ||||||
26 | Section, then that will be considered by the Commission, along |
| |||||||
| |||||||
1 | with all other evidence and in the same manner as all other | ||||||
2 | evidence, in the determination of whether the employer may be | ||||||
3 | responsible for the payment of additional compensation | ||||||
4 | pursuant to Section 19(k) of this Act.
| ||||||
5 | The changes to this Section made by this amendatory Act of | ||||||
6 | the 97th General Assembly apply only to health care services | ||||||
7 | provided or proposed to be provided on or after September 1, | ||||||
8 | 2011. | ||||||
9 | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
| ||||||
10 | (820 ILCS 305/11) (from Ch. 48, par. 138.11)
| ||||||
11 | Sec. 11. The compensation herein provided, together with | ||||||
12 | the
provisions of this Act, shall be the measure of the | ||||||
13 | responsibility of
any employer engaged in any of the | ||||||
14 | enterprises or businesses enumerated
in Section 3 of this Act, | ||||||
15 | or of any employer who is not engaged in any
such enterprises | ||||||
16 | or businesses, but who has elected to provide and pay
| ||||||
17 | compensation for accidental injuries sustained by any employee | ||||||
18 | arising
out of and in the course of the employment according to | ||||||
19 | the provisions
of this Act, and whose election to continue | ||||||
20 | under this Act, has not been
nullified by any action of his | ||||||
21 | employees as provided for in this Act.
| ||||||
22 | Accidental injuries incurred while participating in | ||||||
23 | voluntary recreational
programs including but not limited to | ||||||
24 | athletic events, parties and picnics
do not arise out of and in | ||||||
25 | the course of the employment even though the
employer pays some |
| |||||||
| |||||||
1 | or all of the cost thereof. This exclusion shall not apply
in | ||||||
2 | the event that the injured employee was ordered or assigned by | ||||||
3 | his employer
to participate in the program.
| ||||||
4 | Accidental injuries incurred while participating as a | ||||||
5 | patient in a drug
or alcohol rehabilitation program do not | ||||||
6 | arise out of and in the course
of employment even though the | ||||||
7 | employer pays some or all of the costs thereof. | ||||||
8 | Any injury to or disease or death of an employee arising | ||||||
9 | from the administration of a vaccine, including without | ||||||
10 | limitation smallpox vaccine, to prepare for, or as a response | ||||||
11 | to, a threatened or potential bioterrorist incident to the | ||||||
12 | employee as part of a voluntary inoculation program in | ||||||
13 | connection with the person's employment or in connection with | ||||||
14 | any governmental program or recommendation for the inoculation | ||||||
15 | of workers in the employee's occupation, geographical area, or | ||||||
16 | other category that includes the employee is deemed to arise | ||||||
17 | out of and in the course of the employment for all purposes | ||||||
18 | under this Act. This paragraph added by this amendatory Act of | ||||||
19 | the 93rd General Assembly is declarative of existing law and is | ||||||
20 | not a new enactment.
| ||||||
21 | No compensation shall be payable if (i) the employee's | ||||||
22 | intoxication is the proximate cause of the employee's | ||||||
23 | accidental injury or (ii) at the time the employee incurred the | ||||||
24 | accidental injury, the employee was so intoxicated that the | ||||||
25 | intoxication constituted a departure from the employment. | ||||||
26 | Admissible evidence of the concentration of (1) alcohol, (2) |
| |||||||
| |||||||
1 | cannabis as defined in the Cannabis Control Act, (3) a | ||||||
2 | controlled substance listed in the Illinois Controlled | ||||||
3 | Substances Act, or (4) an intoxicating compound listed in the | ||||||
4 | Use of Intoxicating Compounds Act in the employee's blood, | ||||||
5 | breath, or urine at the time the employee incurred the | ||||||
6 | accidental injury shall be considered in any hearing under this | ||||||
7 | Act to determine whether the employee was intoxicated at the | ||||||
8 | time the employee incurred the accidental injuries. If at the | ||||||
9 | time of the accidental injuries, there was 0.08% or more by | ||||||
10 | weight of alcohol in the employee's blood, breath, or urine or | ||||||
11 | if there is any evidence of impairment due to the unlawful or | ||||||
12 | unauthorized use of (1) cannabis as defined in the Cannabis | ||||||
13 | Control Act, (2) a controlled substance listed in the Illinois | ||||||
14 | Controlled Substances Act, or (3) an intoxicating compound | ||||||
15 | listed in the Use of Intoxicating Compounds Act or if the | ||||||
16 | employee refuses to submit to testing of blood, breath, or | ||||||
17 | urine, then there shall be a rebuttable presumption that the | ||||||
18 | employee was intoxicated and that the intoxication was the | ||||||
19 | proximate cause of the employee's injury. The employee may | ||||||
20 | overcome the rebuttable presumption by the preponderance of the | ||||||
21 | admissible evidence that the intoxication was not the sole | ||||||
22 | proximate cause or proximate cause of the accidental injuries. | ||||||
23 | Percentage by weight of alcohol in the blood shall be based on | ||||||
24 | grams of alcohol per 100 milliliters of blood. Percentage by | ||||||
25 | weight of alcohol in the breath shall be based upon grams of | ||||||
26 | alcohol per 210 liters of breath. Any testing that has not been |
| |||||||
| |||||||
1 | performed by an accredited or certified testing laboratory | ||||||
2 | shall not be admissible in any hearing under this Act to | ||||||
3 | determine whether the employee was intoxicated at the time the | ||||||
4 | employee incurred the accidental injury. | ||||||
5 | All sample collection and testing for alcohol and drugs | ||||||
6 | under this Section shall be performed in accordance with rules | ||||||
7 | to be adopted by the Commission. These rules shall ensure: | ||||||
8 | (1) compliance with the National Labor Relations Act | ||||||
9 | regarding collective bargaining agreements or regulations | ||||||
10 | promulgated by the United States Department of | ||||||
11 | Transportation; | ||||||
12 | (2) that samples are collected and tested in | ||||||
13 | conformance with national and State legal and regulatory | ||||||
14 | standards for the privacy of the individual being tested, | ||||||
15 | and in a manner reasonably calculated to prevent | ||||||
16 | substitutions or interference with the collection or | ||||||
17 | testing of reliable sample; | ||||||
18 | (3) that split testing procedures are utilized; | ||||||
19 | (4) that sample collection is documented, and the | ||||||
20 | documentation procedures include: | ||||||
21 | (A) the labeling of samples in a manner so as to | ||||||
22 | reasonably preclude the probability of erroneous | ||||||
23 | identification of test result; and | ||||||
24 | (B) an opportunity for the employee to provide | ||||||
25 | notification of any information which he or she | ||||||
26 | considers relevant to the test, including |
| |||||||
| |||||||
1 | identification of currently or recently used | ||||||
2 | prescription or nonprescription drugs and other | ||||||
3 | relevant medical information; | ||||||
4 | (5) that sample collection, storage, and | ||||||
5 | transportation to the place of testing is performed in a | ||||||
6 | manner so as to reasonably preclude the probability of | ||||||
7 | sample contamination or adulteration; and | ||||||
8 | (6) that chemical analyses of blood, urine, breath, or | ||||||
9 | other bodily substance are performed according to | ||||||
10 | nationally scientifically accepted analytical methods and | ||||||
11 | procedures. | ||||||
12 | The changes to this Section made by this amendatory Act of | ||||||
13 | the 97th General Assembly apply only to accidental injuries | ||||||
14 | that occur on or after September 1, 2011. | ||||||
15 | (Source: P.A. 93-829, eff. 7-28-04.)
| ||||||
16 | (820 ILCS 305/13) (from Ch. 48, par. 138.13)
| ||||||
17 | Sec. 13. There is created an Illinois Workers' Compensation | ||||||
18 | Commission consisting of 10
members to be appointed by the | ||||||
19 | Governor, by and with the consent of the
Senate, 3 of whom | ||||||
20 | shall be representative citizens of the
employing class | ||||||
21 | operating under this Act and 3 of whom shall
be representative | ||||||
22 | citizens of the class of employees covered under this
Act, and | ||||||
23 | 4 of whom shall be representative citizens not identified
with | ||||||
24 | either the employing or employee classes. Not more than 6 | ||||||
25 | members
of the Commission shall be of the same political party.
|
| |||||||
| |||||||
1 | One of the
members not identified with either the employing | ||||||
2 | or employee classes shall
be designated by the Governor as | ||||||
3 | Chairman. The Chairman shall be the chief
administrative and | ||||||
4 | executive officer of the Commission; and he or she shall
have | ||||||
5 | general supervisory authority over all personnel of the | ||||||
6 | Commission,
including arbitrators and Commissioners, and the | ||||||
7 | final authority in all
administrative matters relating to the | ||||||
8 | Commissioners, including but not
limited to the assignment and | ||||||
9 | distribution of cases and assignment of
Commissioners to the | ||||||
10 | panels, except in the promulgation of procedural rules
and | ||||||
11 | orders under Section 16 and in the determination of cases under | ||||||
12 | this Act.
| ||||||
13 | Notwithstanding the general supervisory authority of the | ||||||
14 | Chairman, each
Commissioner, except those assigned to the | ||||||
15 | temporary panel, shall have the
authority to hire and supervise | ||||||
16 | 2 staff attorneys each. Such staff attorneys
shall report | ||||||
17 | directly to the individual Commissioner.
| ||||||
18 | A formal training program for newly-appointed | ||||||
19 | Commissioners shall be
implemented. The training program shall | ||||||
20 | include the following:
| ||||||
21 | (a) substantive and procedural aspects of the office of | ||||||
22 | Commissioner;
| ||||||
23 | (b) current issues in workers' compensation law and | ||||||
24 | practice;
| ||||||
25 | (c) medical lectures by specialists in areas such as | ||||||
26 | orthopedics,
ophthalmology, psychiatry, rehabilitation |
| |||||||
| |||||||
1 | counseling;
| ||||||
2 | (d) orientation to each operational unit of the | ||||||
3 | Illinois Workers' Compensation Commission;
| ||||||
4 | (e) observation of experienced arbitrators and | ||||||
5 | Commissioners conducting
hearings of cases, combined with | ||||||
6 | the opportunity to discuss evidence
presented and rulings | ||||||
7 | made;
| ||||||
8 | (f) the use of hypothetical cases requiring the | ||||||
9 | newly-appointed
Commissioner to issue judgments as a means | ||||||
10 | to evaluating knowledge and
writing ability;
| ||||||
11 | (g) writing skills ; .
| ||||||
12 | (h) professional and ethical standards pursuant to | ||||||
13 | Section 1.1 of this Act; | ||||||
14 | (i) detection of workers' compensation fraud and | ||||||
15 | reporting obligations of Commission employees and | ||||||
16 | appointees; | ||||||
17 | (j) standards of evidence-based medical treatment and | ||||||
18 | best practices for measuring and improving quality and | ||||||
19 | health care outcomes in the workers' compensation system, | ||||||
20 | including but not limited to the use of the American | ||||||
21 | Medical Association's "Guides to the Evaluation of | ||||||
22 | Permanent Impairment" and the practice of utilization | ||||||
23 | review; and | ||||||
24 | (k) substantive and procedural aspects of coal | ||||||
25 | workers' pneumoconiosis (black lung) cases. | ||||||
26 | A formal and ongoing professional development program |
| |||||||
| |||||||
1 | including, but not
limited to, the above-noted areas shall be | ||||||
2 | implemented to keep
Commissioners informed of recent | ||||||
3 | developments and issues and to assist them
in maintaining and | ||||||
4 | enhancing their professional competence. Each Commissioner | ||||||
5 | shall complete 20 hours of training in the above-noted areas | ||||||
6 | during every 2 years such Commissioner shall remain in office.
| ||||||
7 | The Commissioner candidates, other than the Chairman, must | ||||||
8 | meet one of
the following qualifications: (a) licensed to | ||||||
9 | practice law in the State of
Illinois; or (b) served as an | ||||||
10 | arbitrator at the Illinois Workers' Compensation
Commission | ||||||
11 | for at least 3 years; or (c) has at least 4 years of
| ||||||
12 | professional labor relations experience. The Chairman | ||||||
13 | candidate must have
public or private sector management and | ||||||
14 | budget experience, as determined
by the Governor.
| ||||||
15 | Each Commissioner shall devote full time to his duties and | ||||||
16 | any
Commissioner who is an attorney-at-law shall not engage in | ||||||
17 | the practice
of law, nor shall any Commissioner hold any other | ||||||
18 | office or position of
profit under the United States or this | ||||||
19 | State or any municipal
corporation or political subdivision of | ||||||
20 | this State, nor engage in any other
business, employment, or | ||||||
21 | vocation.
| ||||||
22 | The term of office of each member of the Commission holding | ||||||
23 | office on
the effective date of this amendatory Act of 1989 is | ||||||
24 | abolished, but
the incumbents shall continue to exercise all of | ||||||
25 | the powers and be subject
to all of the duties of Commissioners | ||||||
26 | until their respective successors are
appointed and qualified.
|
| |||||||
| |||||||
1 | The Illinois Workers' Compensation Commission shall | ||||||
2 | administer this Act.
| ||||||
3 | In the promulgation of procedural rules, the determination | ||||||
4 | of cases heard en banc, and other matters determined by the | ||||||
5 | full Commission, the Chairman's vote shall break a tie in the | ||||||
6 | event of a tie vote.
| ||||||
7 | The members shall be appointed by the Governor, with the | ||||||
8 | advice and
consent of the Senate, as follows:
| ||||||
9 | (a) After the effective date of this amendatory Act of | ||||||
10 | 1989, 3
members, at least one of
each political party, and | ||||||
11 | one of whom shall be a representative citizen
of the | ||||||
12 | employing class operating under this Act, one of whom shall | ||||||
13 | be
a representative citizen of the class of employees | ||||||
14 | covered under this
Act, and one of whom shall be a | ||||||
15 | representative citizen not identified
with either the | ||||||
16 | employing or employee classes, shall be appointed
to hold | ||||||
17 | office until the third Monday in January of 1993, and until | ||||||
18 | their
successors are appointed and qualified, and 4 | ||||||
19 | members, one of whom shall be
a representative citizen of | ||||||
20 | the employing class operating under this Act,
one of whom | ||||||
21 | shall be a representative citizen of the class of employees
| ||||||
22 | covered in this Act, and two of whom shall be | ||||||
23 | representative citizens not
identified with either the | ||||||
24 | employing or employee classes, one of whom shall
be | ||||||
25 | designated by the Governor as Chairman (at least one of | ||||||
26 | each of the two
major political parties) shall be appointed |
| |||||||
| |||||||
1 | to hold office until the third
Monday of January in 1991, | ||||||
2 | and until their successors are appointed and
qualified.
| ||||||
3 | (a-5) Notwithstanding any other provision of this | ||||||
4 | Section,
the term of each member of the Commission
who was | ||||||
5 | appointed by the Governor and is in office on June 30, 2003 | ||||||
6 | shall
terminate at the close of business on that date or | ||||||
7 | when all of the successor
members to be appointed pursuant | ||||||
8 | to this amendatory Act of the 93rd General
Assembly have | ||||||
9 | been appointed by the Governor, whichever occurs later. As | ||||||
10 | soon
as possible, the Governor shall appoint persons to | ||||||
11 | fill the vacancies created
by this amendatory Act. Of the | ||||||
12 | initial commissioners appointed pursuant to
this | ||||||
13 | amendatory Act of the 93rd General Assembly, 3 shall be | ||||||
14 | appointed for
terms ending on the third Monday in January, | ||||||
15 | 2005, and 4 shall be appointed
for terms ending on the | ||||||
16 | third Monday in January, 2007.
| ||||||
17 | (a-10) After the effective date of this amendatory Act | ||||||
18 | of the 94th General Assembly, the Commission shall be | ||||||
19 | increased to 10 members. As soon as possible after the | ||||||
20 | effective date of this amendatory Act of the 94th General | ||||||
21 | Assembly, the Governor shall appoint, by and with the | ||||||
22 | consent of the
Senate, the 3 members added to the | ||||||
23 | Commission under this amendatory Act of the 94th General | ||||||
24 | Assembly, one of whom shall be a representative citizen of | ||||||
25 | the employing class operating under this Act, one of whom | ||||||
26 | shall be a representative of the class of employees covered |
| |||||||
| |||||||
1 | under this Act, and one of whom shall be a representative | ||||||
2 | citizen not identified with either the employing or | ||||||
3 | employee classes. Of the members appointed under this | ||||||
4 | amendatory Act of the 94th General Assembly, one shall be | ||||||
5 | appointed for a term ending on the third Monday in January, | ||||||
6 | 2007, and 2 shall be appointed for terms ending on the | ||||||
7 | third Monday in January, 2009, and until their successors | ||||||
8 | are appointed and qualified.
| ||||||
9 | (b) Members shall thereafter be appointed to hold | ||||||
10 | office for terms of 4
years from the third Monday in | ||||||
11 | January of the year of their appointment,
and until their | ||||||
12 | successors are appointed and qualified. All such
| ||||||
13 | appointments shall be made so that the composition of the | ||||||
14 | Commission is in
accordance with the provisions of the | ||||||
15 | first paragraph of this Section.
| ||||||
16 | The Chairman shall receive an annual salary of $42,500, or
| ||||||
17 | a salary set by the Compensation Review Board, whichever is | ||||||
18 | greater,
and each other member shall receive an annual salary | ||||||
19 | of $38,000, or a
salary set by the Compensation Review Board, | ||||||
20 | whichever is greater.
| ||||||
21 | In case of a vacancy in the office of a Commissioner during | ||||||
22 | the
recess of the Senate, the Governor shall make a temporary | ||||||
23 | appointment
until the next meeting of the Senate, when he shall | ||||||
24 | nominate some person
to fill such office. Any person so | ||||||
25 | nominated who is confirmed by the
Senate shall hold office | ||||||
26 | during the remainder of the term and until his
successor is |
| |||||||
| |||||||
1 | appointed and qualified.
| ||||||
2 | The Illinois Workers' Compensation Commission created by | ||||||
3 | this amendatory Act of 1989
shall succeed to all the rights, | ||||||
4 | powers, duties, obligations, records
and other property and | ||||||
5 | employees of the Industrial Commission which it
replaces as | ||||||
6 | modified by this amendatory Act of 1989 and all applications
| ||||||
7 | and reports to actions and proceedings of such prior Industrial | ||||||
8 | Commission
shall be considered as applications and reports to | ||||||
9 | actions and proceedings
of the Illinois Workers' Compensation | ||||||
10 | Commission created by this amendatory Act of 1989.
| ||||||
11 | Notwithstanding any other provision of this Act, in the | ||||||
12 | event the
Chairman shall make a finding that a member is or | ||||||
13 | will be unavailable to
fulfill the responsibilities of his or | ||||||
14 | her office, the Chairman shall
advise the Governor and the | ||||||
15 | member in writing and shall designate a
certified arbitrator to | ||||||
16 | serve as acting Commissioner. The certified
arbitrator shall | ||||||
17 | act as a Commissioner until the member resumes the duties
of | ||||||
18 | his or her office or until a new member is appointed by the | ||||||
19 | Governor, by
and with the consent of the Senate, if a vacancy | ||||||
20 | occurs in the office of
the Commissioner, but in no event shall | ||||||
21 | a certified arbitrator serve in the
capacity of Commissioner | ||||||
22 | for more than 6 months from the date of
appointment by the | ||||||
23 | Chairman. A finding by the Chairman that a member is or
will be | ||||||
24 | unavailable to fulfill the responsibilities of his or her | ||||||
25 | office
shall be based upon notice to the Chairman by a member | ||||||
26 | that he or she will
be unavailable or facts and circumstances |
| |||||||
| |||||||
1 | made known to the Chairman which
lead him to reasonably find | ||||||
2 | that a member is unavailable to fulfill the
responsibilities of | ||||||
3 | his or her office. The designation of a certified
arbitrator to | ||||||
4 | act as a Commissioner shall be considered representative of
| ||||||
5 | citizens not identified with either the employing or employee | ||||||
6 | classes and
the arbitrator shall serve regardless of his or her | ||||||
7 | political affiliation.
A certified arbitrator who serves as an | ||||||
8 | acting Commissioner shall have all
the rights and powers of a | ||||||
9 | Commissioner, including salary.
| ||||||
10 | Notwithstanding any other provision of this Act, the | ||||||
11 | Governor shall appoint
a special panel of Commissioners | ||||||
12 | comprised of 3 members who shall be chosen
by the Governor, by | ||||||
13 | and with the consent of the Senate, from among the
current | ||||||
14 | ranks of certified arbitrators. Three members shall hold office
| ||||||
15 | until the Commission in consultation with the Governor | ||||||
16 | determines that the
caseload on review has been reduced | ||||||
17 | sufficiently to allow cases to proceed
in a timely manner or | ||||||
18 | for a term of 18 months from the effective date of
their | ||||||
19 | appointment by the Governor, whichever shall be earlier. The 3
| ||||||
20 | members shall be considered representative of citizens not | ||||||
21 | identified with
either the employing or employee classes and | ||||||
22 | shall serve regardless of
political affiliation. Each of the 3 | ||||||
23 | members shall have only such rights
and powers of a | ||||||
24 | Commissioner necessary to dispose of those cases assigned
to | ||||||
25 | the special panel. Each of the 3 members appointed to the | ||||||
26 | special panel
shall receive the same salary as other |
| |||||||
| |||||||
1 | Commissioners for the duration of
the panel.
| ||||||
2 | The Commission may have an Executive Director; if so, the | ||||||
3 | Executive
Director shall be appointed by the Governor with the | ||||||
4 | advice and consent of the
Senate. The salary and duties of the | ||||||
5 | Executive Director shall be fixed by the
Commission.
| ||||||
6 | On the effective date of this amendatory Act of
the 93rd | ||||||
7 | General Assembly, the name of the Industrial Commission is | ||||||
8 | changed to the Illinois Workers' Compensation Commission. | ||||||
9 | References in any law, appropriation, rule, form, or other
| ||||||
10 | document: (i) to the Industrial Commission
are deemed, in | ||||||
11 | appropriate contexts, to be references to the Illinois Workers' | ||||||
12 | Compensation Commission for all purposes; (ii) to the | ||||||
13 | Industrial Commission Operations Fund
are deemed, in | ||||||
14 | appropriate contexts, to be references to the Illinois Workers' | ||||||
15 | Compensation Commission Operations Fund for all purposes; | ||||||
16 | (iii) to the Industrial Commission Operations Fund Fee are | ||||||
17 | deemed, in appropriate contexts, to be
references to the | ||||||
18 | Illinois Workers' Compensation Commission Operations Fund Fee | ||||||
19 | for all
purposes; and (iv) to the Industrial Commission | ||||||
20 | Operations Fund Surcharge are deemed, in appropriate contexts, | ||||||
21 | to be
references to the Illinois Workers' Compensation | ||||||
22 | Commission Operations Fund Surcharge for all
purposes. | ||||||
23 | (Source: P.A. 93-509, eff. 8-11-03; 93-721, eff. 1-1-05; | ||||||
24 | 94-277, eff. 7-20-05.)
| ||||||
25 | (820 ILCS 305/13.1) (from Ch. 48, par. 138.13-1)
|
| |||||||
| |||||||
1 | Sec. 13.1. (a) There is created a Workers' Compensation | ||||||
2 | Advisory Board
hereinafter referred to as the Advisory Board. | ||||||
3 | After the effective date of this amendatory Act of the 94th | ||||||
4 | General Assembly, the Advisory Board shall consist of 12 | ||||||
5 | members
appointed by the Governor with the advice and consent | ||||||
6 | of the Senate. Six
members of the Advisory Board shall be
| ||||||
7 | representative citizens chosen from the employee class, and 6 | ||||||
8 | members shall be
representative citizens chosen from the | ||||||
9 | employing class. The Chairman of the Commission shall serve as | ||||||
10 | the ex officio Chairman of the Advisory Board. After the | ||||||
11 | effective date of this amendatory Act of the 94th General | ||||||
12 | Assembly, each member of the Advisory Board shall serve a
term | ||||||
13 | ending on the third Monday in January 2007 and shall continue | ||||||
14 | to serve until his or her successor is appointed and qualified. | ||||||
15 | Members of the Advisory Board shall thereafter be appointed for | ||||||
16 | 4 year terms from the third Monday in January of the year of | ||||||
17 | their appointment, and until their successors are appointed and | ||||||
18 | qualified.
Seven members
of the Advisory Board shall constitute | ||||||
19 | a quorum to do business, but in no
case shall there be less | ||||||
20 | than one representative from each class. A vacancy on the | ||||||
21 | Advisory Board shall be
filled by the Governor for the | ||||||
22 | unexpired term.
| ||||||
23 | (b) Members of the Advisory Board shall receive no | ||||||
24 | compensation for
their services but shall be reimbursed for | ||||||
25 | expenses incurred in the
performance of their duties by the | ||||||
26 | Commission from appropriations made to
the Commission for such |
| |||||||
| |||||||
1 | purpose.
| ||||||
2 | (c) The Advisory Board shall aid the Commission in | ||||||
3 | formulating policies,
discussing problems, setting priorities | ||||||
4 | of expenditures, reviewing advisory rates filed by an advisory | ||||||
5 | organization as defined in Section 463 of the Illinois | ||||||
6 | Insurance Code, and establishing
short and long range | ||||||
7 | administrative goals. Prior to making the (1) initial set of | ||||||
8 | arbitrator appointments pursuant to this amendatory Act of the | ||||||
9 | 97th General Assembly and (2) appointment of Commissioners, | ||||||
10 | appointments to the Commission, the Governor shall request that | ||||||
11 | the Advisory Board make recommendations as to candidates to | ||||||
12 | consider for appointment and the Advisory Board may then make | ||||||
13 | such recommendations.
| ||||||
14 | (d) The terms of all Advisory Board members serving on the | ||||||
15 | effective date of this amendatory Act of the 97th General | ||||||
16 | Assembly are terminated. The Governor shall appoint new members | ||||||
17 | to the Advisory Board within 30 days after the effective date | ||||||
18 | of the amendatory Act of the 97th General Assembly, subject to | ||||||
19 | the advice and consent of the Senate. | ||||||
20 | (Source: P.A. 94-277, eff. 7-20-05; 94-695, eff. 11-16-05.)
| ||||||
21 | (820 ILCS 305/14) (from Ch. 48, par. 138.14)
| ||||||
22 | Sec. 14. The Commission shall appoint a secretary, an | ||||||
23 | assistant
secretary, and arbitrators and shall employ such
| ||||||
24 | assistants and clerical help as may be necessary. Arbitrators | ||||||
25 | shall be appointed pursuant to this Section, notwithstanding |
| |||||||
| |||||||
1 | any provision of the Personnel Code.
| ||||||
2 | Each arbitrator appointed after November 22, 1977 shall be | ||||||
3 | required
to demonstrate in writing and in accordance with
the | ||||||
4 | rules and regulations of the Illinois Department of Central | ||||||
5 | Management
Services his or
her knowledge of and expertise in | ||||||
6 | the law of and judicial processes of
the Workers' Compensation | ||||||
7 | Act and the Occupational Diseases Act.
| ||||||
8 | A formal training program for newly-hired arbitrators | ||||||
9 | shall be
implemented. The training program shall include the | ||||||
10 | following:
| ||||||
11 | (a) substantive and procedural aspects of the | ||||||
12 | arbitrator position;
| ||||||
13 | (b) current issues in workers' compensation law and | ||||||
14 | practice;
| ||||||
15 | (c) medical lectures by specialists in areas such as | ||||||
16 | orthopedics,
ophthalmology, psychiatry, rehabilitation | ||||||
17 | counseling;
| ||||||
18 | (d) orientation to each operational unit of the | ||||||
19 | Illinois Workers' Compensation Commission;
| ||||||
20 | (e) observation of experienced arbitrators conducting | ||||||
21 | hearings of cases,
combined with the opportunity to discuss | ||||||
22 | evidence presented and rulings made;
| ||||||
23 | (f) the use of hypothetical cases requiring the trainee | ||||||
24 | to issue
judgments as a means to evaluating knowledge and | ||||||
25 | writing ability;
| ||||||
26 | (g) writing skills ; .
|
| |||||||
| |||||||
1 | (h) professional and ethical standards pursuant to | ||||||
2 | Section 1.1 of this Act; | ||||||
3 | (i) detection of workers' compensation fraud and | ||||||
4 | reporting obligations of Commission employees and | ||||||
5 | appointees; | ||||||
6 | (j) standards of evidence-based medical treatment and | ||||||
7 | best practices for measuring and improving quality and | ||||||
8 | health care outcomes in the workers' compensation system, | ||||||
9 | including but not limited to the use of the American | ||||||
10 | Medical Association's "Guides to the Evaluation of | ||||||
11 | Permanent Impairment" and the practice of utilization | ||||||
12 | review; and | ||||||
13 | (k) substantive and procedural aspects of coal | ||||||
14 | workers' pneumoconiosis (black lung) cases. | ||||||
15 | A formal and ongoing professional development program | ||||||
16 | including, but not
limited to, the above-noted areas shall be | ||||||
17 | implemented to keep arbitrators
informed of recent | ||||||
18 | developments and issues and to assist them in
maintaining and | ||||||
19 | enhancing their professional competence. Each arbitrator shall | ||||||
20 | complete 20 hours of training in the above-noted areas during | ||||||
21 | every 2 years such arbitrator shall remain in office.
| ||||||
22 | Each
arbitrator shall devote full time to his or her duties | ||||||
23 | and shall serve when
assigned as
an acting Commissioner when a | ||||||
24 | Commissioner is unavailable in accordance
with the provisions | ||||||
25 | of Section 13 of this Act. Any
arbitrator who is an | ||||||
26 | attorney-at-law shall not engage in the practice of
law, nor |
| |||||||
| |||||||
1 | shall any arbitrator hold any other office or position of
| ||||||
2 | profit under the United States or this State or any municipal
| ||||||
3 | corporation or political subdivision of this State.
| ||||||
4 | Notwithstanding any other provision of this Act to the | ||||||
5 | contrary, an arbitrator
who serves as an acting Commissioner in | ||||||
6 | accordance with the provisions of
Section 13 of this Act shall | ||||||
7 | continue to serve in the capacity of Commissioner
until a | ||||||
8 | decision is reached in every case heard by that arbitrator | ||||||
9 | while
serving as an acting Commissioner.
| ||||||
10 | Notwithstanding any other provision of this Section, the | ||||||
11 | term of all arbitrators serving on the effective date of this | ||||||
12 | amendatory Act of the 97th General Assembly, including any | ||||||
13 | arbitrators on administrative leave, shall terminate at the | ||||||
14 | close of business on July 1, 2011, but the incumbents shall | ||||||
15 | continue to exercise all of their duties until they are | ||||||
16 | reappointed or their successors are appointed. | ||||||
17 | On and after the effective date of this amendatory Act of | ||||||
18 | the 97th General Assembly, arbitrators shall be appointed to | ||||||
19 | 3-year terms by the full Commission, except that initial | ||||||
20 | appointments made on and after the effective date of this | ||||||
21 | amendatory Act of the 97th General Assembly shall be made as | ||||||
22 | follows: | ||||||
23 | (1) All appointments shall be made by the Governor with | ||||||
24 | the advice and consent of the Senate. | ||||||
25 | (2) 12 arbitrators shall be appointed to terms expiring | ||||||
26 | July 1, 2012; 12 arbitrators shall be appointed to terms |
| |||||||
| |||||||
1 | expiring July 1, 2013; and all additional arbitrators shall | ||||||
2 | be appointed to terms expiring July 1, 2014. | ||||||
3 | Upon the expiration of a term, the Chairman shall evaluate | ||||||
4 | the performance of the arbitrator and may recommend that he or | ||||||
5 | she be reappointed to a second or subsequent term by the full | ||||||
6 | Commission. | ||||||
7 | Each arbitrator appointed on or after the effective date of | ||||||
8 | this amendatory Act of the 97th General Assembly and who has | ||||||
9 | not previously served as an arbitrator for the Commission shall | ||||||
10 | be required to be authorized to practice law in this State by | ||||||
11 | the Supreme Court, and to maintain this authorization | ||||||
12 | throughout his or her term of employment. | ||||||
13 | Each arbitrator appointed after the effective date of this | ||||||
14 | amendatory
Act of 1989 shall be appointed for a term of 6 | ||||||
15 | years. Each arbitrator
shall be appointed for a subsequent term | ||||||
16 | unless the Chairman makes a
recommendation to the Commission, | ||||||
17 | no later than 60 days prior to the
expiration of the term, not | ||||||
18 | to reappoint the arbitrator. Notice of such a
recommendation | ||||||
19 | shall also be given to the arbitrator no later than 60 days
| ||||||
20 | prior to the expiration of the term. Upon
such recommendation | ||||||
21 | by the Chairman, the arbitrator shall be appointed for
a | ||||||
22 | subsequent term unless 8 of 10 members of the Commission, | ||||||
23 | including the
Chairman, vote not to reappoint the arbitrator.
| ||||||
24 | All arbitrators shall be subject to the provisions of the | ||||||
25 | Personnel Code,
and the performance of all arbitrators shall be | ||||||
26 | reviewed by the Chairman on
an annual basis. The changes made |
| |||||||
| |||||||
1 | to this Section by this amendatory Act of the 97th General | ||||||
2 | Assembly shall prevail over any conflict with the Personnel | ||||||
3 | Code. The Chairman shall allow input from the Commissioners in
| ||||||
4 | all such reviews.
| ||||||
5 | The Commission shall assign no fewer than 3 arbitrators to | ||||||
6 | each hearing site. The Commission shall establish a procedure | ||||||
7 | to ensure that the arbitrators assigned to each hearing site | ||||||
8 | are assigned cases on a random basis. No arbitrator shall hear | ||||||
9 | cases in any county, other than Cook County, for more than 2 | ||||||
10 | years in each 3-year term. | ||||||
11 | The Secretary and each arbitrator shall receive a per annum | ||||||
12 | salary of
$4,000 less than the per annum salary of members of | ||||||
13 | The
Illinois Workers' Compensation Commission as
provided in | ||||||
14 | Section 13 of this Act, payable in equal monthly installments.
| ||||||
15 | The members of the Commission, Arbitrators and other | ||||||
16 | employees whose
duties require them to travel, shall have | ||||||
17 | reimbursed to them their
actual traveling expenses and | ||||||
18 | disbursements made or incurred by them in
the discharge of | ||||||
19 | their official duties while away from their place of
residence | ||||||
20 | in the performance of their duties.
| ||||||
21 | The Commission shall provide itself with a seal for the
| ||||||
22 | authentication of its orders, awards and proceedings upon which | ||||||
23 | shall be
inscribed the name of the Commission and the words | ||||||
24 | "Illinois--Seal".
| ||||||
25 | The Secretary or Assistant Secretary, under the direction | ||||||
26 | of the
Commission, shall have charge and custody of the seal of |
| |||||||
| |||||||
1 | the Commission
and also have charge and custody of all records, | ||||||
2 | files, orders,
proceedings, decisions, awards and other | ||||||
3 | documents on file with the
Commission. He shall furnish | ||||||
4 | certified copies, under the seal of the
Commission, of any such | ||||||
5 | records, files, orders, proceedings, decisions,
awards and | ||||||
6 | other documents on file with the Commission as may be
required. | ||||||
7 | Certified copies so furnished by the Secretary or Assistant
| ||||||
8 | Secretary shall be received in evidence before the Commission | ||||||
9 | or any
Arbitrator thereof, and in all courts, provided that the | ||||||
10 | original of
such certified copy is otherwise competent and | ||||||
11 | admissible in evidence.
The Secretary or Assistant Secretary | ||||||
12 | shall perform such other duties as
may be prescribed from time | ||||||
13 | to time by the Commission.
| ||||||
14 | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
| ||||||
15 | (820 ILCS 305/16b new) | ||||||
16 | Sec. 16b. Gift ban. | ||||||
17 | (a) An attorney appearing before the Commission shall not | ||||||
18 | provide compensation or any gift to any person in exchange for | ||||||
19 | the referral of a client involving a matter to be heard before | ||||||
20 | the Commission except for a division of a fee between lawyers | ||||||
21 | who are not in the same firm in accordance with Rule 1.5 of the | ||||||
22 | Code of Professional Responsibility. For purposes of this | ||||||
23 | Section, "gift" means any gratuity, discount, entertainment, | ||||||
24 | hospitality, loan, forbearance, or any other tangible or | ||||||
25 | intangible item having monetary value including, but not |
| |||||||
| |||||||
1 | limited to, cash, food and drink, and honoraria except for food | ||||||
2 | or refreshments not exceeding $75 per person in value on a | ||||||
3 | single calendar day, provided that the food or refreshments are | ||||||
4 | (1) consumed on the premises from which they were purchased or | ||||||
5 | prepared or (2) catered. "Catered" means food or refreshments | ||||||
6 | that are purchased ready to eat and delivered by any means. | ||||||
7 | (b) Violation of this Section is a Class A misdemeanor.
| ||||||
8 | (820 ILCS 305/18) (from Ch. 48, par. 138.18)
| ||||||
9 | Sec. 18.
All questions arising under this Act, if not | ||||||
10 | settled by
agreement of the parties interested therein, shall, | ||||||
11 | except as otherwise
provided, be determined by the Commission. | ||||||
12 | Claims from current and former employees of the Commission | ||||||
13 | shall be determined in accordance with Section 18.1 of this | ||||||
14 | Act.
| ||||||
15 | (Source: Laws 1951, p. 1060.)
| ||||||
16 | (820 ILCS 305/18.1 new) | ||||||
17 | Sec. 18.1. Claims by former and current employees of the | ||||||
18 | Commission. All claims by current and former employees and | ||||||
19 | appointees of the Commission shall be assigned to a certified | ||||||
20 | independent arbitrator not employed by the Commission | ||||||
21 | designated by the Chairman. The Chairman shall designate an | ||||||
22 | arbitrator from a list of approved certified arbitrators | ||||||
23 | provided by the Commission Review Board. If the Chairman is the | ||||||
24 | claimant, then the independent arbitrator from the approved |
| |||||||
| |||||||
1 | list shall be designated by the longest serving Commissioner. | ||||||
2 | The designated independent arbitrator shall have the authority | ||||||
3 | of arbitrators of the Commission regarding settlement and | ||||||
4 | adjudication of the claim of the current and former employees | ||||||
5 | and appointees of the Commission. The decision of the | ||||||
6 | independent arbitrator shall become the decision of the | ||||||
7 | Commission. An appeal of the independent arbitrator's decision | ||||||
8 | shall be subject to judicial review in accordance with | ||||||
9 | subsection (f) of Section 19.
| ||||||
10 | (820 ILCS 305/19) (from Ch. 48, par. 138.19)
| ||||||
11 | Sec. 19. Any disputed questions of law or fact shall be | ||||||
12 | determined
as herein provided.
| ||||||
13 | (a) It shall be the duty of the Commission upon | ||||||
14 | notification that
the parties have failed to reach an | ||||||
15 | agreement, to designate an Arbitrator.
| ||||||
16 | 1. Whenever any claimant misconceives his remedy and | ||||||
17 | files an
application for adjustment of claim under this Act | ||||||
18 | and it is
subsequently discovered, at any time before final | ||||||
19 | disposition of such
cause, that the claim for disability or | ||||||
20 | death which was the basis for
such application should | ||||||
21 | properly have been made under the Workers'
Occupational | ||||||
22 | Diseases Act, then the provisions of Section 19, paragraph
| ||||||
23 | (a-1) of the Workers' Occupational Diseases Act having | ||||||
24 | reference to such
application shall apply.
| ||||||
25 | 2. Whenever any claimant misconceives his remedy and |
| |||||||
| |||||||
1 | files an
application for adjustment of claim under the | ||||||
2 | Workers' Occupational
Diseases Act and it is subsequently | ||||||
3 | discovered, at any time before final
disposition of such | ||||||
4 | cause that the claim for injury or death which was
the | ||||||
5 | basis for such application should properly have been made | ||||||
6 | under this
Act, then the application so filed under the | ||||||
7 | Workers' Occupational
Diseases Act may be amended in form, | ||||||
8 | substance or both to assert claim
for such disability or | ||||||
9 | death under this Act and it shall be deemed to
have been so | ||||||
10 | filed as amended on the date of the original filing
| ||||||
11 | thereof, and such compensation may be awarded as is | ||||||
12 | warranted by the
whole evidence pursuant to this Act. When | ||||||
13 | such amendment is submitted,
further or additional | ||||||
14 | evidence may be heard by the Arbitrator or
Commission when | ||||||
15 | deemed necessary. Nothing in this Section contained
shall | ||||||
16 | be construed to be or permit a waiver of any provisions of | ||||||
17 | this
Act with reference to notice but notice if given shall | ||||||
18 | be deemed to be a
notice under the provisions of this Act | ||||||
19 | if given within the time
required herein.
| ||||||
20 | (b) The Arbitrator shall make such inquiries and | ||||||
21 | investigations as he or
they shall deem necessary and may | ||||||
22 | examine and inspect all books, papers,
records, places, or | ||||||
23 | premises relating to the questions in dispute and hear
such | ||||||
24 | proper evidence as the parties may submit.
| ||||||
25 | The hearings before the Arbitrator shall be held in the | ||||||
26 | vicinity where
the injury occurred after 10 days' notice of the |
| |||||||
| |||||||
1 | time and place of such
hearing shall have been given to each of | ||||||
2 | the parties or their attorneys
of record.
| ||||||
3 | The Arbitrator may find that the disabling condition is | ||||||
4 | temporary and has
not yet reached a permanent condition and may | ||||||
5 | order the payment of
compensation up to the date of the | ||||||
6 | hearing, which award shall be reviewable
and enforceable in the | ||||||
7 | same manner as other awards, and in no instance be a
bar to a | ||||||
8 | further hearing and determination of a further amount of | ||||||
9 | temporary
total compensation or of compensation for permanent | ||||||
10 | disability, but shall
be conclusive as to all other questions | ||||||
11 | except the nature and extent of said
disability.
| ||||||
12 | The decision of the Arbitrator shall be filed with the | ||||||
13 | Commission which
Commission shall immediately send to each | ||||||
14 | party or his attorney a copy of
such decision, together with a | ||||||
15 | notification of the time when it was filed.
As of the effective | ||||||
16 | date of this amendatory Act of the 94th General Assembly, all | ||||||
17 | decisions of the Arbitrator shall set forth
in writing findings | ||||||
18 | of fact and conclusions of law, separately stated, if requested | ||||||
19 | by either party.
Unless a petition for review is filed by | ||||||
20 | either party within 30 days after
the receipt by such party of | ||||||
21 | the copy of the decision and notification of
time when filed, | ||||||
22 | and unless such party petitioning for a review shall
within 35 | ||||||
23 | days after the receipt by him of the copy of the decision, file
| ||||||
24 | with the Commission either an agreed statement of the facts | ||||||
25 | appearing upon
the hearing before the Arbitrator, or if such
| ||||||
26 | party shall so elect a correct transcript of evidence of the |
| |||||||
| |||||||
1 | proceedings
at such hearings, then the decision shall become | ||||||
2 | the decision of the
Commission and in the absence of fraud | ||||||
3 | shall be conclusive.
The Petition for Review shall contain a | ||||||
4 | statement of the petitioning party's
specific exceptions to the | ||||||
5 | decision of the arbitrator. The jurisdiction
of the Commission | ||||||
6 | to review the decision of the arbitrator shall not be
limited | ||||||
7 | to the exceptions stated in the Petition for Review.
The | ||||||
8 | Commission, or any member thereof, may grant further time not | ||||||
9 | exceeding
30 days, in which to file such agreed statement or | ||||||
10 | transcript of
evidence. Such agreed statement of facts or | ||||||
11 | correct transcript of
evidence, as the case may be, shall be | ||||||
12 | authenticated by the signatures
of the parties or their | ||||||
13 | attorneys, and in the event they do not agree as
to the | ||||||
14 | correctness of the transcript of evidence it shall be | ||||||
15 | authenticated
by the signature of the Arbitrator designated by | ||||||
16 | the Commission.
| ||||||
17 | Whether the employee is working or not, if the employee is | ||||||
18 | not receiving or has not received medical, surgical, or | ||||||
19 | hospital services or other services or compensation as provided | ||||||
20 | in paragraph (a) of Section 8, or compensation as provided in | ||||||
21 | paragraph (b) of Section 8, the employee may at any time | ||||||
22 | petition for an expedited hearing by an Arbitrator on the issue | ||||||
23 | of whether or not he or she is entitled to receive payment of | ||||||
24 | the services or compensation. Provided the employer continues | ||||||
25 | to pay compensation pursuant to paragraph (b) of Section 8, the | ||||||
26 | employer may at any time petition for an expedited hearing on |
| |||||||
| |||||||
1 | the issue of whether or not the employee is entitled to receive | ||||||
2 | medical, surgical, or hospital services or other services or | ||||||
3 | compensation as provided in paragraph (a) of Section 8, or | ||||||
4 | compensation as provided in paragraph (b) of Section 8. When an | ||||||
5 | employer has petitioned for an expedited hearing, the employer | ||||||
6 | shall continue to pay compensation as provided in paragraph (b) | ||||||
7 | of Section 8 unless the arbitrator renders a decision that the | ||||||
8 | employee is not entitled to the benefits that are the subject | ||||||
9 | of the expedited hearing or unless the employee's treating | ||||||
10 | physician has released the employee to return to work at his or | ||||||
11 | her regular job with the employer or the employee actually | ||||||
12 | returns to work at any other job. If the arbitrator renders a | ||||||
13 | decision that the employee is not entitled to the benefits that | ||||||
14 | are the subject of the expedited hearing, a petition for review | ||||||
15 | filed by the employee shall receive the same priority as if the | ||||||
16 | employee had filed a petition for an expedited hearing by an | ||||||
17 | Arbitrator. Neither party shall be entitled to an expedited | ||||||
18 | hearing when the employee has returned to work and the sole | ||||||
19 | issue in dispute amounts to less than 12 weeks of unpaid | ||||||
20 | compensation pursuant to paragraph (b) of Section 8. | ||||||
21 | Expedited hearings shall have priority over all other | ||||||
22 | petitions and shall be heard by the Arbitrator and Commission | ||||||
23 | with all convenient speed. Any party requesting an expedited | ||||||
24 | hearing shall give notice of a request for an expedited hearing | ||||||
25 | under this paragraph. A copy of the Application for Adjustment | ||||||
26 | of Claim shall be attached to the notice. The Commission shall |
| |||||||
| |||||||
1 | adopt rules and procedures under which the final decision of | ||||||
2 | the Commission under this paragraph is filed not later than 180 | ||||||
3 | days from the date that the Petition for Review is filed with | ||||||
4 | the Commission. | ||||||
5 | Where 2 or more insurance carriers, private self-insureds, | ||||||
6 | or a group workers' compensation pool under Article V 3/4 of | ||||||
7 | the Illinois Insurance Code dispute coverage for the same | ||||||
8 | injury, any such insurance carrier, private self-insured, or | ||||||
9 | group workers' compensation pool may request an expedited | ||||||
10 | hearing pursuant to this paragraph to determine the issue of | ||||||
11 | coverage, provided coverage is the only issue in dispute and | ||||||
12 | all other issues are stipulated and agreed to and further | ||||||
13 | provided that all compensation benefits including medical | ||||||
14 | benefits pursuant to Section 8(a) continue to be paid to or on | ||||||
15 | behalf of petitioner. Any insurance carrier, private | ||||||
16 | self-insured, or group workers' compensation pool that is | ||||||
17 | determined to be liable for coverage for the injury in issue | ||||||
18 | shall reimburse any insurance carrier, private self-insured, | ||||||
19 | or group workers' compensation pool that has paid benefits to | ||||||
20 | or on behalf of petitioner for the injury.
| ||||||
21 | (b-1) If the employee is not receiving medical, surgical or | ||||||
22 | hospital
services as provided in paragraph (a) of Section 8 or | ||||||
23 | compensation as
provided in paragraph (b) of Section 8, the | ||||||
24 | employee, in accordance with
Commission Rules, may file a | ||||||
25 | petition for an emergency hearing by an
Arbitrator on the issue | ||||||
26 | of whether or not he is entitled to receive payment
of such |
| |||||||
| |||||||
1 | compensation or services as provided therein. Such petition | ||||||
2 | shall
have priority over all other petitions and shall be heard | ||||||
3 | by the Arbitrator
and Commission with all convenient speed.
| ||||||
4 | Such petition shall contain the following information and | ||||||
5 | shall be served
on the employer at least 15 days before it is | ||||||
6 | filed:
| ||||||
7 | (i) the date and approximate time of accident;
| ||||||
8 | (ii) the approximate location of the accident;
| ||||||
9 | (iii) a description of the accident;
| ||||||
10 | (iv) the nature of the injury incurred by the employee;
| ||||||
11 | (v) the identity of the person, if known, to whom the | ||||||
12 | accident was
reported and the date on which it was | ||||||
13 | reported;
| ||||||
14 | (vi) the name and title of the person, if known, | ||||||
15 | representing the
employer with whom the employee conferred | ||||||
16 | in any effort to obtain
compensation pursuant to paragraph | ||||||
17 | (b) of Section 8 of this Act or medical,
surgical or | ||||||
18 | hospital services pursuant to paragraph (a) of Section 8 of
| ||||||
19 | this Act and the date of such conference;
| ||||||
20 | (vii) a statement that the employer has refused to pay | ||||||
21 | compensation
pursuant to paragraph (b) of Section 8 of this | ||||||
22 | Act or for medical, surgical
or hospital services pursuant | ||||||
23 | to paragraph (a) of Section 8 of this Act;
| ||||||
24 | (viii) the name and address, if known, of each witness | ||||||
25 | to the accident
and of each other person upon whom the | ||||||
26 | employee will rely to support his
allegations;
|
| |||||||
| |||||||
1 | (ix) the dates of treatment related to the accident by | ||||||
2 | medical
practitioners, and the names and addresses of such | ||||||
3 | practitioners, including
the dates of treatment related to | ||||||
4 | the accident at any hospitals and the
names and addresses | ||||||
5 | of such hospitals, and a signed authorization
permitting | ||||||
6 | the employer to examine all medical records of all | ||||||
7 | practitioners
and hospitals named pursuant to this | ||||||
8 | paragraph;
| ||||||
9 | (x) a copy of a signed report by a medical | ||||||
10 | practitioner, relating to the
employee's current inability | ||||||
11 | to return to work because of the injuries
incurred as a | ||||||
12 | result of the accident or such other documents or | ||||||
13 | affidavits
which show that the employee is entitled to | ||||||
14 | receive compensation pursuant
to paragraph (b) of Section 8 | ||||||
15 | of this Act or medical, surgical or hospital
services | ||||||
16 | pursuant to paragraph (a) of Section 8 of this Act. Such | ||||||
17 | reports,
documents or affidavits shall state, if possible, | ||||||
18 | the history of the
accident given by the employee, and | ||||||
19 | describe the injury and medical
diagnosis, the medical | ||||||
20 | services for such injury which the employee has
received | ||||||
21 | and is receiving, the physical activities which the | ||||||
22 | employee
cannot currently perform as a result of any | ||||||
23 | impairment or disability due to
such injury, and the | ||||||
24 | prognosis for recovery;
| ||||||
25 | (xi) complete copies of any reports, records, | ||||||
26 | documents and affidavits
in the possession of the employee |
| |||||||
| |||||||
1 | on which the employee will rely to
support his allegations, | ||||||
2 | provided that the employer shall pay the
reasonable cost of | ||||||
3 | reproduction thereof;
| ||||||
4 | (xii) a list of any reports, records, documents and | ||||||
5 | affidavits which
the employee has demanded by subpoena and | ||||||
6 | on which he intends to
rely to support his allegations;
| ||||||
7 | (xiii) a certification signed by the employee or his | ||||||
8 | representative that
the employer has received the petition | ||||||
9 | with the required information 15
days before filing.
| ||||||
10 | Fifteen days after receipt by the employer of the petition | ||||||
11 | with the
required information the employee may file said | ||||||
12 | petition and required
information and shall serve notice of the | ||||||
13 | filing upon the employer. The
employer may file a motion | ||||||
14 | addressed to the sufficiency of the petition.
If an objection | ||||||
15 | has been filed to the sufficiency of the petition, the
| ||||||
16 | arbitrator shall rule on the objection within 2 working days. | ||||||
17 | If such an
objection is filed, the time for filing the final | ||||||
18 | decision of the
Commission as provided in this paragraph shall | ||||||
19 | be tolled until the
arbitrator has determined that the petition | ||||||
20 | is sufficient.
| ||||||
21 | The employer shall, within 15 days after receipt of the | ||||||
22 | notice that such
petition is filed, file with the Commission | ||||||
23 | and serve on the employee or
his representative a written | ||||||
24 | response to each claim set forth in the
petition, including the | ||||||
25 | legal and factual basis for each disputed
allegation and the | ||||||
26 | following information: (i) complete copies of any
reports, |
| |||||||
| |||||||
1 | records, documents and affidavits in the possession of the
| ||||||
2 | employer on which the employer intends to rely in support of | ||||||
3 | his response,
(ii) a list of any reports, records, documents | ||||||
4 | and affidavits which the
employer has demanded by subpoena and | ||||||
5 | on which the employer intends to rely
in support of his | ||||||
6 | response, (iii) the name and address of each witness on
whom | ||||||
7 | the employer will rely to support his response, and (iv) the | ||||||
8 | names and
addresses of any medical practitioners selected by | ||||||
9 | the employer pursuant to
Section 12 of this Act and the time | ||||||
10 | and place of any examination scheduled
to be made pursuant to | ||||||
11 | such Section.
| ||||||
12 | Any employer who does not timely file and serve a written | ||||||
13 | response
without good cause may not introduce any evidence to | ||||||
14 | dispute any claim of
the employee but may cross examine the | ||||||
15 | employee or any witness brought by
the employee and otherwise | ||||||
16 | be heard.
| ||||||
17 | No document or other evidence not previously identified by | ||||||
18 | either party
with the petition or written response, or by any | ||||||
19 | other means before the
hearing, may be introduced into evidence | ||||||
20 | without good cause.
If, at the hearing, material information is | ||||||
21 | discovered which was
not previously disclosed, the Arbitrator | ||||||
22 | may extend the time for closing
proof on the motion of a party | ||||||
23 | for a reasonable period of time which may
be more than 30 days. | ||||||
24 | No evidence may be introduced pursuant
to this paragraph as to | ||||||
25 | permanent disability. No award may be entered for
permanent | ||||||
26 | disability pursuant to this paragraph. Either party may |
| |||||||
| |||||||
1 | introduce
into evidence the testimony taken by deposition of | ||||||
2 | any medical practitioner.
| ||||||
3 | The Commission shall adopt rules, regulations and | ||||||
4 | procedures whereby the
final decision of the Commission is | ||||||
5 | filed not later than 90 days from the
date the petition for | ||||||
6 | review is filed but in no event later than 180 days from
the | ||||||
7 | date the petition for an emergency hearing is filed with the | ||||||
8 | Illinois Workers' Compensation
Commission.
| ||||||
9 | All service required pursuant to this paragraph (b-1) must | ||||||
10 | be by personal
service or by certified mail and with evidence | ||||||
11 | of receipt. In addition for
the purposes of this paragraph, all | ||||||
12 | service on the employer must be at the
premises where the | ||||||
13 | accident occurred if the premises are owned or operated
by the | ||||||
14 | employer. Otherwise service must be at the employee's principal
| ||||||
15 | place of employment by the employer. If service on the employer | ||||||
16 | is not
possible at either of the above, then service shall be | ||||||
17 | at the employer's
principal place of business. After initial | ||||||
18 | service in each case, service
shall be made on the employer's | ||||||
19 | attorney or designated representative.
| ||||||
20 | (c) (1) At a reasonable time in advance of and in | ||||||
21 | connection with the
hearing under Section 19(e) or 19(h), the | ||||||
22 | Commission may on its own motion
order an impartial physical or | ||||||
23 | mental examination of a petitioner whose
mental or physical | ||||||
24 | condition is in issue, when in the Commission's
discretion it | ||||||
25 | appears that such an examination will materially aid in the
| ||||||
26 | just determination of the case. The examination shall be made |
| |||||||
| |||||||
1 | by a member
or members of a panel of physicians chosen for | ||||||
2 | their special qualifications
by the Illinois State Medical | ||||||
3 | Society. The Commission shall establish
procedures by which a | ||||||
4 | physician shall be selected from such list.
| ||||||
5 | (2) Should the Commission at any time during the hearing | ||||||
6 | find that
compelling considerations make it advisable to have | ||||||
7 | an examination and
report at that time, the commission may in | ||||||
8 | its discretion so order.
| ||||||
9 | (3) A copy of the report of examination shall be given to | ||||||
10 | the Commission
and to the attorneys for the parties.
| ||||||
11 | (4) Either party or the Commission may call the examining | ||||||
12 | physician or
physicians to testify. Any physician so called | ||||||
13 | shall be subject to
cross-examination.
| ||||||
14 | (5) The examination shall be made, and the physician or | ||||||
15 | physicians, if
called, shall testify, without cost to the | ||||||
16 | parties. The Commission shall
determine the compensation and | ||||||
17 | the pay of the physician or physicians. The
compensation for | ||||||
18 | this service shall not exceed the usual and customary amount
| ||||||
19 | for such service.
| ||||||
20 | (6) The fees and payment thereof of all attorneys and | ||||||
21 | physicians for
services authorized by the Commission under this | ||||||
22 | Act shall, upon request
of either the employer or the employee | ||||||
23 | or the beneficiary affected, be
subject to the review and | ||||||
24 | decision of the Commission.
| ||||||
25 | (d) If any employee shall persist in insanitary or | ||||||
26 | injurious
practices which tend to either imperil or retard his |
| |||||||
| |||||||
1 | recovery or shall
refuse to submit to such medical, surgical, | ||||||
2 | or hospital treatment as is
reasonably essential to promote his | ||||||
3 | recovery, the Commission may, in its
discretion, reduce or | ||||||
4 | suspend the compensation of any such injured
employee. However, | ||||||
5 | when an employer and employee so agree in writing,
the | ||||||
6 | foregoing provision shall not be construed to authorize the
| ||||||
7 | reduction or suspension of compensation of an employee who is | ||||||
8 | relying in
good faith, on treatment by prayer or spiritual | ||||||
9 | means alone, in
accordance with the tenets and practice of a | ||||||
10 | recognized church or
religious denomination, by a duly | ||||||
11 | accredited practitioner thereof.
| ||||||
12 | (e) This paragraph shall apply to all hearings before the | ||||||
13 | Commission.
Such hearings may be held in its office or | ||||||
14 | elsewhere as the Commission
may deem advisable. The taking of | ||||||
15 | testimony on such hearings may be had
before any member of the | ||||||
16 | Commission. If a petition for review and agreed
statement of | ||||||
17 | facts or transcript of evidence is filed, as provided herein,
| ||||||
18 | the Commission shall promptly review the decision of the | ||||||
19 | Arbitrator and all
questions of law or fact which appear from | ||||||
20 | the statement of facts or
transcript of evidence.
| ||||||
21 | In all cases in which the hearing before the arbitrator is | ||||||
22 | held after
December 18, 1989, no additional evidence shall be | ||||||
23 | introduced by the
parties before the Commission on review of | ||||||
24 | the decision of the Arbitrator.
In reviewing decisions of an | ||||||
25 | arbitrator the Commission shall award such
temporary | ||||||
26 | compensation, permanent compensation and other payments as are
|
| |||||||
| |||||||
1 | due under this Act. The Commission shall file in its office its | ||||||
2 | decision
thereon, and shall immediately send to each party or | ||||||
3 | his attorney a copy of
such decision and a notification of the | ||||||
4 | time when it was filed. Decisions
shall be filed within 60 days | ||||||
5 | after the Statement of Exceptions and
Supporting Brief and | ||||||
6 | Response thereto are required to be filed or oral
argument | ||||||
7 | whichever is later.
| ||||||
8 | In the event either party requests oral argument, such | ||||||
9 | argument shall be
had before a panel of 3 members of the | ||||||
10 | Commission (or before all available
members pursuant to the | ||||||
11 | determination of 7 members of the Commission that
such argument | ||||||
12 | be held before all available members of the Commission)
| ||||||
13 | pursuant to the rules and regulations of the Commission. A | ||||||
14 | panel of 3
members, which shall be comprised of not more than | ||||||
15 | one representative
citizen of the employing class and not more | ||||||
16 | than one representative citizen
of the employee class, shall | ||||||
17 | hear the argument; provided that if all the
issues in dispute | ||||||
18 | are solely the nature and extent of the permanent partial
| ||||||
19 | disability, if any, a majority of the panel may deny the | ||||||
20 | request for such
argument and such argument shall not be held; | ||||||
21 | and provided further that 7
members of the Commission may | ||||||
22 | determine that the argument be held before
all available | ||||||
23 | members of the Commission. A decision of the Commission
shall | ||||||
24 | be approved by a majority of Commissioners present at such | ||||||
25 | hearing if
any; provided, if no such hearing is held, a | ||||||
26 | decision of the Commission
shall be approved by a majority of a |
| |||||||
| |||||||
1 | panel of 3 members of the Commission
as described in this | ||||||
2 | Section. The Commission shall give 10 days' notice to
the | ||||||
3 | parties or their attorneys of the time and place of such taking | ||||||
4 | of
testimony and of such argument.
| ||||||
5 | In any case the Commission in its decision may find | ||||||
6 | specially
upon any question or questions of law or fact which | ||||||
7 | shall be submitted
in writing by either party whether ultimate | ||||||
8 | or otherwise;
provided that on issues other than nature and | ||||||
9 | extent of the disability,
if any, the Commission in its | ||||||
10 | decision shall find specially upon any
question or questions of | ||||||
11 | law or fact, whether ultimate or otherwise,
which are submitted | ||||||
12 | in writing by either party; provided further that
not more than | ||||||
13 | 5 such questions may be submitted by either party. Any
party | ||||||
14 | may, within 20 days after receipt of notice of the Commission's
| ||||||
15 | decision, or within such further time, not exceeding 30 days, | ||||||
16 | as the
Commission may grant, file with the Commission either an | ||||||
17 | agreed
statement of the facts appearing upon the hearing, or, | ||||||
18 | if such party
shall so elect, a correct transcript of evidence | ||||||
19 | of the additional
proceedings presented before the Commission, | ||||||
20 | in which report the party
may embody a correct statement of | ||||||
21 | such other proceedings in the case as
such party may desire to | ||||||
22 | have reviewed, such statement of facts or
transcript of | ||||||
23 | evidence to be authenticated by the signature of the
parties or | ||||||
24 | their attorneys, and in the event that they do not agree,
then | ||||||
25 | the authentication of such transcript of evidence shall be by | ||||||
26 | the
signature of any member of the Commission.
|
| |||||||
| |||||||
1 | If a reporter does not for any reason furnish a transcript | ||||||
2 | of the
proceedings before the Arbitrator in any case for use on | ||||||
3 | a hearing for
review before the Commission, within the | ||||||
4 | limitations of time as fixed in
this Section, the Commission | ||||||
5 | may, in its discretion, order a trial de
novo before the | ||||||
6 | Commission in such case upon application of either
party. The | ||||||
7 | applications for adjustment of claim and other documents in
the | ||||||
8 | nature of pleadings filed by either party, together with the
| ||||||
9 | decisions of the Arbitrator and of the Commission and the | ||||||
10 | statement of
facts or transcript of evidence hereinbefore | ||||||
11 | provided for in paragraphs
(b) and (c) shall be the record of | ||||||
12 | the proceedings of the Commission,
and shall be subject to | ||||||
13 | review as hereinafter provided.
| ||||||
14 | At the request of either party or on its own motion, the | ||||||
15 | Commission shall
set forth in writing the reasons for the | ||||||
16 | decision, including findings of
fact and conclusions of law | ||||||
17 | separately stated. The Commission shall by rule
adopt a format | ||||||
18 | for written decisions for the Commission and arbitrators.
The | ||||||
19 | written decisions shall be concise and shall succinctly state | ||||||
20 | the facts
and reasons for the decision. The Commission may | ||||||
21 | adopt in whole or in part,
the decision of the arbitrator as | ||||||
22 | the decision of the Commission. When the
Commission does so | ||||||
23 | adopt the decision of the arbitrator, it shall do so by
order. | ||||||
24 | Whenever the Commission adopts part of the arbitrator's | ||||||
25 | decision,
but not all, it shall include in the order the | ||||||
26 | reasons for not adopting all
of the arbitrator's decision. When |
| |||||||
| |||||||
1 | a majority of a panel, after
deliberation, has arrived at its | ||||||
2 | decision, the decision shall be filed as
provided in this | ||||||
3 | Section without unnecessary delay, and without regard to
the | ||||||
4 | fact that a member of the panel has expressed an intention to | ||||||
5 | dissent.
Any member of the panel may file a dissent. Any | ||||||
6 | dissent shall be filed no
later than 10 days after the decision | ||||||
7 | of the majority has been filed.
| ||||||
8 | Decisions rendered by the Commission and dissents, if any, | ||||||
9 | shall be
published together by the Commission. The conclusions | ||||||
10 | of law set out in
such decisions shall be regarded as | ||||||
11 | precedents by arbitrators for the purpose
of achieving a more | ||||||
12 | uniform administration of this Act.
| ||||||
13 | (f) The decision of the Commission acting within its | ||||||
14 | powers,
according to the provisions of paragraph (e) of this | ||||||
15 | Section shall, in
the absence of fraud, be conclusive unless | ||||||
16 | reviewed as in this paragraph
hereinafter provided. However, | ||||||
17 | the Arbitrator or the Commission may on
his or its own motion, | ||||||
18 | or on the motion of either party, correct any
clerical error or | ||||||
19 | errors in computation within 15 days after the date of
receipt | ||||||
20 | of any award by such Arbitrator or any decision on review of | ||||||
21 | the
Commission and shall have the power to recall the original | ||||||
22 | award on
arbitration or decision on review, and issue in lieu | ||||||
23 | thereof such
corrected award or decision. Where such correction | ||||||
24 | is made the time for
review herein specified shall begin to run | ||||||
25 | from the date of
the receipt of the corrected award or | ||||||
26 | decision.
|
| |||||||
| |||||||
1 | (1) Except in cases of claims against the State of | ||||||
2 | Illinois other than those claims under Section 18.1 , in
| ||||||
3 | which case the decision of the Commission shall not be | ||||||
4 | subject to
judicial review, the Circuit Court of the county | ||||||
5 | where any of the
parties defendant may be found, or if none | ||||||
6 | of the parties defendant can
be found in this State then | ||||||
7 | the Circuit Court of the county where the
accident | ||||||
8 | occurred, shall by summons to the Commission have
power to | ||||||
9 | review all questions of law and fact presented by such | ||||||
10 | record.
| ||||||
11 | A proceeding for review shall be commenced within 20 | ||||||
12 | days of
the receipt of notice of the decision of the | ||||||
13 | Commission. The summons shall
be issued by the clerk of | ||||||
14 | such court upon written request returnable on a
designated | ||||||
15 | return day, not less than 10 or more than 60 days from the | ||||||
16 | date
of issuance thereof, and the written request shall | ||||||
17 | contain the last known
address of other parties in interest | ||||||
18 | and their attorneys of record who are
to be served by | ||||||
19 | summons. Service upon any member of the Commission or the
| ||||||
20 | Secretary or the Assistant Secretary thereof shall be | ||||||
21 | service upon the
Commission, and service upon other parties | ||||||
22 | in interest and their attorneys
of record shall be by | ||||||
23 | summons, and such service shall be made upon the
Commission | ||||||
24 | and other parties in interest by mailing notices of the
| ||||||
25 | commencement of the proceedings and the return day of the | ||||||
26 | summons to the
office of the Commission and to the last |
| |||||||
| |||||||
1 | known place of residence of other
parties in interest or | ||||||
2 | their attorney or attorneys of record. The clerk of
the | ||||||
3 | court issuing the summons shall on the day of issue mail | ||||||
4 | notice of the
commencement of the proceedings which shall | ||||||
5 | be done by mailing a copy of
the summons to the office of | ||||||
6 | the Commission, and a copy of the summons to
the other | ||||||
7 | parties in interest or their attorney or attorneys of | ||||||
8 | record and
the clerk of the court shall make certificate | ||||||
9 | that he has so sent said
notices in pursuance of this | ||||||
10 | Section, which shall be evidence of service on
the | ||||||
11 | Commission and other parties in interest.
| ||||||
12 | The Commission shall not be required to certify the | ||||||
13 | record of their
proceedings to the Circuit Court, unless | ||||||
14 | the party commencing the
proceedings for review in the | ||||||
15 | Circuit Court as above provided, shall pay
to the | ||||||
16 | Commission the sum of 80¢ per page of testimony taken | ||||||
17 | before the
Commission, and 35¢ per page of all other | ||||||
18 | matters contained in such
record, except as otherwise | ||||||
19 | provided by Section 20 of this Act. Payment
for photostatic | ||||||
20 | copies of exhibit shall be extra. It shall be the duty
of | ||||||
21 | the Commission upon such payment, or failure to pay as | ||||||
22 | permitted
under Section 20 of this Act, to prepare a true | ||||||
23 | and correct typewritten
copy of such testimony and a true | ||||||
24 | and correct copy of all other matters
contained in such | ||||||
25 | record and certified to by the Secretary or Assistant
| ||||||
26 | Secretary thereof.
|
| |||||||
| |||||||
1 | In its decision on review the Commission shall | ||||||
2 | determine in each
particular case the amount of the | ||||||
3 | probable cost of the record to be
filed as a part of the | ||||||
4 | summons in that case and no request for a summons
may be | ||||||
5 | filed and no summons shall issue unless the party seeking | ||||||
6 | to review
the decision of the Commission shall exhibit to | ||||||
7 | the clerk of the Circuit
Court proof of payment by filing a | ||||||
8 | receipt showing payment or an affidavit
of the attorney | ||||||
9 | setting forth that payment has been made of the sums so
| ||||||
10 | determined to the Secretary or Assistant Secretary of the | ||||||
11 | Commission,
except as otherwise provided by Section 20 of | ||||||
12 | this Act.
| ||||||
13 | (2) No such summons shall issue unless the one against | ||||||
14 | whom the
Commission shall have rendered an award for the | ||||||
15 | payment of money shall upon
the filing of his written | ||||||
16 | request for such summons file with the clerk of
the court a | ||||||
17 | bond conditioned that if he shall not successfully
| ||||||
18 | prosecute the review, he will pay the award and the costs | ||||||
19 | of the
proceedings in the courts. The amount of the bond | ||||||
20 | shall be fixed by any
member of the Commission and the | ||||||
21 | surety or sureties of the bond shall be
approved by the | ||||||
22 | clerk of the court. The acceptance of the bond by the
clerk | ||||||
23 | of the court shall constitute evidence of his approval of | ||||||
24 | the bond.
| ||||||
25 | Every county, city, town, township, incorporated | ||||||
26 | village, school
district, body politic or municipal |
| |||||||
| |||||||
1 | corporation against whom the
Commission shall have | ||||||
2 | rendered an award for the payment of money shall
not be | ||||||
3 | required to file a bond to secure the payment of the award | ||||||
4 | and
the costs of the proceedings in the court to authorize | ||||||
5 | the court to
issue such summons.
| ||||||
6 | The court may confirm or set aside the decision of the | ||||||
7 | Commission. If
the decision is set aside and the facts | ||||||
8 | found in the proceedings before
the Commission are | ||||||
9 | sufficient, the court may enter such decision as is
| ||||||
10 | justified by law, or may remand the cause to the Commission | ||||||
11 | for further
proceedings and may state the questions | ||||||
12 | requiring further hearing, and
give such other | ||||||
13 | instructions as may be proper. Appeals shall be taken
to | ||||||
14 | the Appellate Court in accordance
with Supreme Court Rules | ||||||
15 | 22(g) and 303. Appeals
shall be taken from the Appellate
| ||||||
16 | Court to the Supreme Court in accordance with Supreme Court | ||||||
17 | Rule 315.
| ||||||
18 | It shall be the duty of the clerk of any court | ||||||
19 | rendering a decision
affecting or affirming an award of the | ||||||
20 | Commission to promptly furnish
the Commission with a copy | ||||||
21 | of such decision, without charge.
| ||||||
22 | The decision of a majority of the members of the panel | ||||||
23 | of the Commission,
shall be considered the decision of the | ||||||
24 | Commission.
| ||||||
25 | (g) Except in the case of a claim against the State of | ||||||
26 | Illinois,
either party may present a certified copy of the |
| |||||||
| |||||||
1 | award of the
Arbitrator, or a certified copy of the decision of | ||||||
2 | the Commission when
the same has become final, when no | ||||||
3 | proceedings for review are pending,
providing for the payment | ||||||
4 | of compensation according to this Act, to the
Circuit Court of | ||||||
5 | the county in which such accident occurred or either of
the | ||||||
6 | parties are residents, whereupon the court shall enter a | ||||||
7 | judgment
in accordance therewith. In a case where the employer | ||||||
8 | refuses to pay
compensation according to such final award or | ||||||
9 | such final decision upon
which such judgment is entered the | ||||||
10 | court shall in entering judgment
thereon, tax as costs against | ||||||
11 | him the reasonable costs and attorney fees
in the arbitration | ||||||
12 | proceedings and in the court entering the judgment
for the | ||||||
13 | person in whose favor the judgment is entered, which judgment
| ||||||
14 | and costs taxed as therein provided shall, until and unless set | ||||||
15 | aside,
have the same effect as though duly entered in an action | ||||||
16 | duly tried and
determined by the court, and shall with like | ||||||
17 | effect, be entered and
docketed. The Circuit Court shall have | ||||||
18 | power at any time upon
application to make any such judgment | ||||||
19 | conform to any modification
required by any subsequent decision | ||||||
20 | of the Supreme Court upon appeal, or
as the result of any | ||||||
21 | subsequent proceedings for review, as provided in
this Act.
| ||||||
22 | Judgment shall not be entered until 15 days' notice of the | ||||||
23 | time and
place of the application for the entry of judgment | ||||||
24 | shall be served upon
the employer by filing such notice with | ||||||
25 | the Commission, which Commission
shall, in case it has on file | ||||||
26 | the address of the employer or the name
and address of its |
| |||||||
| |||||||
1 | agent upon whom notices may be served, immediately
send a copy | ||||||
2 | of the notice to the employer or such designated agent.
| ||||||
3 | (h) An agreement or award under this Act providing for | ||||||
4 | compensation
in installments, may at any time within 18 months | ||||||
5 | after such agreement
or award be reviewed by the Commission at | ||||||
6 | the request of either the
employer or the employee, on the | ||||||
7 | ground that the disability of the
employee has subsequently | ||||||
8 | recurred, increased, diminished or ended.
| ||||||
9 | However, as to accidents occurring subsequent to July 1, | ||||||
10 | 1955, which
are covered by any agreement or award under this | ||||||
11 | Act providing for
compensation in installments made as a result | ||||||
12 | of such accident, such
agreement or award may at any time | ||||||
13 | within 30 months, or 60 months in the case of an award under | ||||||
14 | Section 8(d)1, after such agreement
or award be reviewed by the | ||||||
15 | Commission at the request of either the
employer or the | ||||||
16 | employee on the ground that the disability of the
employee has | ||||||
17 | subsequently recurred, increased, diminished or ended.
| ||||||
18 | On such review, compensation payments may be | ||||||
19 | re-established,
increased, diminished or ended. The Commission | ||||||
20 | shall give 15 days'
notice to the parties of the hearing for | ||||||
21 | review. Any employee, upon any
petition for such review being | ||||||
22 | filed by the employer, shall be entitled
to one day's notice | ||||||
23 | for each 100 miles necessary to be traveled by him in
attending | ||||||
24 | the hearing of the Commission upon the petition, and 3 days in
| ||||||
25 | addition thereto. Such employee shall, at the discretion of the
| ||||||
26 | Commission, also be entitled to 5 cents per mile necessarily |
| |||||||
| |||||||
1 | traveled by
him within the State of Illinois in attending such | ||||||
2 | hearing, not to
exceed a distance of 300 miles, to be taxed by | ||||||
3 | the Commission as costs
and deposited with the petition of the | ||||||
4 | employer.
| ||||||
5 | When compensation which is payable in accordance with an | ||||||
6 | award or
settlement contract approved by the Commission, is | ||||||
7 | ordered paid in a
lump sum by the Commission, no review shall | ||||||
8 | be had as in this paragraph
mentioned.
| ||||||
9 | (i) Each party, upon taking any proceedings or steps | ||||||
10 | whatsoever
before any Arbitrator, Commission or court, shall | ||||||
11 | file with the Commission
his address, or the name and address | ||||||
12 | of any agent upon whom all notices to
be given to such party | ||||||
13 | shall be served, either personally or by registered
mail, | ||||||
14 | addressed to such party or agent at the last address so filed | ||||||
15 | with
the Commission. In the event such party has not filed his | ||||||
16 | address, or the
name and address of an agent as above provided, | ||||||
17 | service of any notice may
be had by filing such notice with the | ||||||
18 | Commission.
| ||||||
19 | (j) Whenever in any proceeding testimony has been taken or | ||||||
20 | a final
decision has been rendered and after the taking of such | ||||||
21 | testimony or
after such decision has become final, the injured | ||||||
22 | employee dies, then in
any subsequent proceedings brought by | ||||||
23 | the personal representative or
beneficiaries of the deceased | ||||||
24 | employee, such testimony in the former
proceeding may be | ||||||
25 | introduced with the same force and effect as though
the witness | ||||||
26 | having so testified were present in person in such
subsequent |
| |||||||
| |||||||
1 | proceedings and such final decision, if any, shall be taken
as | ||||||
2 | final adjudication of any of the issues which are the same in | ||||||
3 | both
proceedings.
| ||||||
4 | (k) In case where there has been any unreasonable or | ||||||
5 | vexatious delay
of payment or intentional underpayment of | ||||||
6 | compensation, or proceedings
have been instituted or carried on | ||||||
7 | by the one liable to pay the
compensation, which do not present | ||||||
8 | a real controversy, but are merely
frivolous or for delay, then | ||||||
9 | the Commission may award compensation
additional to that | ||||||
10 | otherwise payable under this Act equal to 50% of the
amount | ||||||
11 | payable at the time of such award. Failure to pay compensation
| ||||||
12 | in accordance with the provisions of Section 8, paragraph (b) | ||||||
13 | of this
Act, shall be considered unreasonable delay.
| ||||||
14 | When determining whether this subsection (k) shall apply, | ||||||
15 | the
Commission shall consider whether an Arbitrator has | ||||||
16 | determined
that the claim is not compensable or whether the | ||||||
17 | employer has
made payments under Section 8(j). | ||||||
18 | (l) If the employee has made written demand for payment of
| ||||||
19 | benefits under Section 8(a) or Section 8(b), the employer shall
| ||||||
20 | have 14 days after receipt of the demand to set forth in
| ||||||
21 | writing the reason for the delay. In the case of demand for
| ||||||
22 | payment of medical benefits under Section 8(a), the time for
| ||||||
23 | the employer to respond shall not commence until the expiration
| ||||||
24 | of the allotted 30 60 days specified under Section 8.2(d). In | ||||||
25 | case
the employer or his or her insurance carrier shall without | ||||||
26 | good and
just cause fail, neglect, refuse, or unreasonably |
| |||||||
| |||||||
1 | delay the
payment of benefits under Section 8(a) or Section | ||||||
2 | 8(b), the
Arbitrator or the Commission shall allow to the | ||||||
3 | employee
additional compensation in the sum of $30 per day for | ||||||
4 | each day
that the benefits under Section 8(a) or Section 8(b) | ||||||
5 | have been
so withheld or refused, not to exceed $10,000.
A | ||||||
6 | delay in payment of 14 days or more
shall create a rebuttable | ||||||
7 | presumption of unreasonable delay.
| ||||||
8 | (m) If the commission finds that an accidental injury was | ||||||
9 | directly
and proximately caused by the employer's wilful | ||||||
10 | violation of a health
and safety standard under the Health and | ||||||
11 | Safety Act in force at the time of the
accident, the arbitrator | ||||||
12 | or the Commission shall allow to the injured
employee or his | ||||||
13 | dependents, as the case may be, additional compensation
equal | ||||||
14 | to 25% of the amount which otherwise would be payable under the
| ||||||
15 | provisions of this Act exclusive of this paragraph. The | ||||||
16 | additional
compensation herein provided shall be allowed by an | ||||||
17 | appropriate increase
in the applicable weekly compensation | ||||||
18 | rate.
| ||||||
19 | (n) After June 30, 1984, decisions of the Illinois Workers' | ||||||
20 | Compensation Commission
reviewing an award of an arbitrator of | ||||||
21 | the Commission shall draw interest
at a rate equal to the yield | ||||||
22 | on indebtedness issued by the United States
Government with a | ||||||
23 | 26-week maturity next previously auctioned on the day on
which | ||||||
24 | the decision is filed. Said rate of interest shall be set forth | ||||||
25 | in
the Arbitrator's Decision. Interest shall be drawn from the | ||||||
26 | date of the
arbitrator's award on all accrued compensation due |
| |||||||
| |||||||
1 | the employee through the
day prior to the date of payments. | ||||||
2 | However, when an employee appeals an
award of an Arbitrator or | ||||||
3 | the Commission, and the appeal results in no
change or a | ||||||
4 | decrease in the award, interest shall not further accrue from
| ||||||
5 | the date of such appeal.
| ||||||
6 | The employer or his insurance carrier may tender the | ||||||
7 | payments due under
the award to stop the further accrual of | ||||||
8 | interest on such award
notwithstanding the prosecution by | ||||||
9 | either party of review, certiorari,
appeal to the Supreme Court | ||||||
10 | or other steps to reverse, vacate or modify
the award.
| ||||||
11 | (o) By the 15th day of each month each insurer providing | ||||||
12 | coverage for
losses under this Act shall notify each insured | ||||||
13 | employer of any compensable
claim incurred during the preceding | ||||||
14 | month and the amounts paid or reserved
on the claim including a | ||||||
15 | summary of the claim and a brief statement of the
reasons for | ||||||
16 | compensability. A cumulative report of all claims incurred
| ||||||
17 | during a calendar year or continued from the previous year | ||||||
18 | shall be
furnished to the insured employer by the insurer | ||||||
19 | within 30 days after the
end of that calendar year.
| ||||||
20 | The insured employer may challenge, in proceeding before | ||||||
21 | the Commission,
payments made by the insurer without | ||||||
22 | arbitration and payments
made after a case is determined to be | ||||||
23 | noncompensable. If the Commission
finds that the case was not | ||||||
24 | compensable, the insurer shall purge its records
as to that | ||||||
25 | employer of any loss or expense associated with the claim, | ||||||
26 | reimburse
the employer for attorneys' fees arising from the |
| |||||||
| |||||||
1 | challenge and for any
payment required of the employer to the | ||||||
2 | Rate Adjustment Fund or the
Second Injury Fund, and may not | ||||||
3 | reflect the loss or expense for rate making
purposes. The | ||||||
4 | employee shall not be required to refund the challenged
| ||||||
5 | payment. The decision of the Commission may be reviewed in the | ||||||
6 | same manner
as in arbitrated cases. No challenge may be | ||||||
7 | initiated under this paragraph
more than 3 years after the | ||||||
8 | payment is made. An employer may waive the
right of challenge | ||||||
9 | under this paragraph on a case by case basis.
| ||||||
10 | (p) After filing an application for adjustment of claim but | ||||||
11 | prior to
the hearing on arbitration the parties may voluntarily | ||||||
12 | agree to submit such
application for adjustment of claim for | ||||||
13 | decision by an arbitrator under
this subsection (p) where such | ||||||
14 | application for adjustment of claim raises
only a dispute over | ||||||
15 | temporary total disability, permanent partial
disability or | ||||||
16 | medical expenses. Such agreement shall be in writing in such
| ||||||
17 | form as provided by the Commission. Applications for adjustment | ||||||
18 | of claim
submitted for decision by an arbitrator under this | ||||||
19 | subsection (p) shall
proceed according to rule as established | ||||||
20 | by the Commission. The Commission
shall promulgate rules | ||||||
21 | including, but not limited to, rules to ensure that
the parties | ||||||
22 | are adequately informed of their rights under this subsection
| ||||||
23 | (p) and of the voluntary nature of proceedings under this | ||||||
24 | subsection (p).
The findings of fact made by an arbitrator | ||||||
25 | acting within his or her powers
under this subsection (p) in | ||||||
26 | the absence of fraud shall be conclusive.
However, the |
| |||||||
| |||||||
1 | arbitrator may on his own motion, or the motion of either
| ||||||
2 | party, correct any clerical errors or errors in computation | ||||||
3 | within 15 days
after the date of receipt of such award of the | ||||||
4 | arbitrator
and shall have the power to recall the original | ||||||
5 | award on arbitration, and
issue in lieu thereof such corrected | ||||||
6 | award.
The decision of the arbitrator under this subsection (p) | ||||||
7 | shall be
considered the decision of the Commission and | ||||||
8 | proceedings for review of
questions of law arising from the | ||||||
9 | decision may be commenced by either party
pursuant to | ||||||
10 | subsection (f) of Section 19. The Advisory Board established
| ||||||
11 | under Section 13.1 shall compile a list of certified Commission
| ||||||
12 | arbitrators, each of whom shall be approved by at least 7 | ||||||
13 | members of the
Advisory Board. The chairman shall select 5 | ||||||
14 | persons from such list to
serve as arbitrators under this | ||||||
15 | subsection (p). By agreement, the parties
shall select one | ||||||
16 | arbitrator from among the 5 persons selected by the
chairman | ||||||
17 | except that if the parties do not agree on an arbitrator from
| ||||||
18 | among the 5 persons, the parties may, by agreement, select an | ||||||
19 | arbitrator of
the American Arbitration Association, whose fee | ||||||
20 | shall be paid by the State
in accordance with rules promulgated | ||||||
21 | by the Commission. Arbitration under
this subsection (p) shall | ||||||
22 | be voluntary.
| ||||||
23 | (Source: P.A. 93-721, eff. 1-1-05; 94-277, eff. 7-20-05.)
| ||||||
24 | (820 ILCS 305/25.5)
| ||||||
25 | Sec. 25.5. Unlawful acts; penalties. |
| |||||||
| |||||||
1 | (a) It is unlawful for any person, company, corporation, | ||||||
2 | insurance carrier, healthcare provider, or other entity to: | ||||||
3 | (1) Intentionally present or cause to be presented any | ||||||
4 | false or
fraudulent claim for the payment of any workers' | ||||||
5 | compensation
benefit.
| ||||||
6 | (2) Intentionally make or cause to be made any false or
| ||||||
7 | fraudulent material statement or material representation | ||||||
8 | for the
purpose of obtaining or denying any workers' | ||||||
9 | compensation
benefit.
| ||||||
10 | (3) Intentionally make or cause to be made any false or
| ||||||
11 | fraudulent statements with regard to entitlement to | ||||||
12 | workers'
compensation benefits with the intent to prevent | ||||||
13 | an injured
worker from making a legitimate claim for any | ||||||
14 | workers'
compensation benefits.
| ||||||
15 | (4) Intentionally prepare or provide an invalid, | ||||||
16 | false, or
counterfeit certificate of insurance as proof of | ||||||
17 | workers'
compensation insurance.
| ||||||
18 | (5) Intentionally make or cause to be made any false or
| ||||||
19 | fraudulent material statement or material representation | ||||||
20 | for the
purpose of obtaining workers' compensation | ||||||
21 | insurance at less
than the proper rate for that insurance.
| ||||||
22 | (6) Intentionally make or cause to be made any false or
| ||||||
23 | fraudulent material statement or material representation | ||||||
24 | on an
initial or renewal self-insurance application or | ||||||
25 | accompanying
financial statement for the purpose of | ||||||
26 | obtaining self-insurance
status or reducing the amount of |
| |||||||
| |||||||
1 | security that may be required
to be furnished pursuant to | ||||||
2 | Section 4 of this Act.
| ||||||
3 | (7) Intentionally make or cause to be made any false or
| ||||||
4 | fraudulent material statement to the Department Division | ||||||
5 | of Insurance's
fraud and insurance non-compliance unit in | ||||||
6 | the course of an
investigation of fraud or insurance | ||||||
7 | non-compliance.
| ||||||
8 | (8) Intentionally assist, abet, solicit, or conspire | ||||||
9 | with any
person, company, or other entity to commit any of | ||||||
10 | the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) | ||||||
11 | of this subsection (a).
| ||||||
12 | (9) Intentionally present a bill or statement for the | ||||||
13 | payment for medical services that were not provided. | ||||||
14 | For the purposes of paragraphs (2), (3), (5), (6), and (7), | ||||||
15 | and (9), the term "statement" includes any writing, notice, | ||||||
16 | proof of injury, bill for services, hospital or doctor records | ||||||
17 | and reports, or X-ray and test results.
| ||||||
18 | (b) Sentences for violations of subsection (a) are as | ||||||
19 | follows: Any person violating subsection (a) is guilty of a | ||||||
20 | Class 4 felony. Any person or entity convicted of any violation | ||||||
21 | of this Section shall be ordered to pay complete restitution to | ||||||
22 | any person or entity so defrauded in addition to any fine or | ||||||
23 | sentence imposed as a result of the conviction.
| ||||||
24 | (1) A violation in which the value of the property | ||||||
25 | obtained or attempted to be obtained is $300 or less is a | ||||||
26 | Class A misdemeanor. |
| |||||||
| |||||||
1 | (2) A violation in which the value of the property | ||||||
2 | obtained or attempted to be obtained is more than $300 but | ||||||
3 | not more than $10,000 is a Class 3 felony. | ||||||
4 | (3) A violation in which the value of the property | ||||||
5 | obtained or attempted to be obtained is more than $10,000 | ||||||
6 | but not more than $100,000 is a Class 2 felony. | ||||||
7 | (4) A violation in which the value of the property | ||||||
8 | obtained or attempted to be obtained is more than $100,000 | ||||||
9 | is a Class 1 felony. | ||||||
10 | (5) A person convicted under this Section shall be | ||||||
11 | ordered to pay monetary restitution to the insurance | ||||||
12 | company or self-insured entity or any other person for any | ||||||
13 | financial loss sustained as a result of a violation of this | ||||||
14 | Section, including any court costs and attorney fees. An | ||||||
15 | order of restitution also includes expenses incurred and | ||||||
16 | paid by the State of Illinois or an insurance company or | ||||||
17 | self-insured entity in connection with any medical | ||||||
18 | evaluation or treatment services. | ||||||
19 | For the purposes of this Section, where the exact value of | ||||||
20 | property obtained or attempted to be obtained is either not | ||||||
21 | alleged or is not specifically set by the terms of a policy of | ||||||
22 | insurance, the value of the property shall be the fair market | ||||||
23 | replacement value of the property claimed to be lost, the | ||||||
24 | reasonable costs of reimbursing a vendor or other claimant for | ||||||
25 | services to be rendered, or both. Notwithstanding the | ||||||
26 | foregoing, an insurance company, self-insured entity, or any |
| |||||||
| |||||||
1 | other person suffering financial loss sustained as a result of | ||||||
2 | violation of this Section may seek restitution, including court | ||||||
3 | costs and attorney's fees in a civil action in a court of | ||||||
4 | competent jurisdiction. | ||||||
5 | (c) The Department Division of Insurance of the Department | ||||||
6 | of Financial and Professional Regulation shall establish a | ||||||
7 | fraud and insurance non-compliance unit responsible for | ||||||
8 | investigating incidences of fraud and insurance non-compliance | ||||||
9 | pursuant to this Section. The size of the staff of the unit | ||||||
10 | shall be subject to appropriation by the General Assembly. It | ||||||
11 | shall be the duty of the fraud and insurance non-compliance | ||||||
12 | unit to determine the identity of insurance carriers, | ||||||
13 | employers, employees, or other persons or entities who have | ||||||
14 | violated the fraud and insurance non-compliance provisions of | ||||||
15 | this Section. The fraud and insurance non-compliance unit shall | ||||||
16 | report violations of the fraud and insurance non-compliance | ||||||
17 | provisions of this Section to the Special Prosecutions Bureau | ||||||
18 | of the Criminal Division of the Office of the Attorney General | ||||||
19 | or to the State's Attorney of the county in which the offense | ||||||
20 | allegedly occurred, either of whom has the authority to | ||||||
21 | prosecute violations under this Section.
| ||||||
22 | With respect to the subject of any investigation being | ||||||
23 | conducted, the fraud and insurance non-compliance unit shall | ||||||
24 | have the general power of subpoena of the Department Division | ||||||
25 | of Insurance , including the authority to issue a subpoena to a | ||||||
26 | medical provider, pursuant to Section 8-802 of the Code of |
| |||||||
| |||||||
1 | Civil Procedure .
| ||||||
2 | (d) Any person may report allegations of insurance | ||||||
3 | non-compliance and fraud pursuant to this Section to the | ||||||
4 | Department Division of Insurance's fraud and insurance | ||||||
5 | non-compliance unit whose duty it shall be to investigate the | ||||||
6 | report. The unit shall notify the Commission of reports of | ||||||
7 | insurance non-compliance. Any person reporting an allegation | ||||||
8 | of insurance non-compliance or fraud against either an employee | ||||||
9 | or employer under this Section must identify himself. Except as | ||||||
10 | provided in this subsection and in subsection (e), all reports | ||||||
11 | shall remain confidential except to refer an investigation to | ||||||
12 | the Attorney General or State's Attorney for prosecution or if | ||||||
13 | the fraud and insurance non-compliance unit's investigation | ||||||
14 | reveals that the conduct reported may be in violation of other | ||||||
15 | laws or regulations of the State of Illinois, the unit may | ||||||
16 | report such conduct to the appropriate governmental agency | ||||||
17 | charged with administering such laws and regulations. Any | ||||||
18 | person who intentionally makes a false report under this | ||||||
19 | Section to the fraud and insurance non-compliance unit is | ||||||
20 | guilty of a Class A misdemeanor.
| ||||||
21 | (e) In order for the fraud and insurance non-compliance | ||||||
22 | unit to investigate a report of fraud related to an employee's | ||||||
23 | claim by an employee , (i) the employee must have filed with the | ||||||
24 | Commission an Application for Adjustment of Claim and the | ||||||
25 | employee must have either received or attempted to receive | ||||||
26 | benefits under this Act that are related to the reported fraud |
| |||||||
| |||||||
1 | or (ii) the employee must have made a written demand for the | ||||||
2 | payment of benefits that are related to the reported fraud. | ||||||
3 | Upon receipt of a report of fraud, the employee or employer | ||||||
4 | shall receive immediate notice of the reported conduct, | ||||||
5 | including the verified name and address of the complainant if | ||||||
6 | that complainant is connected to the case and the nature of the | ||||||
7 | reported conduct. The fraud and insurance non-compliance unit | ||||||
8 | shall resolve all reports of fraud against employees or | ||||||
9 | employers within 120 days of receipt of the report. There shall | ||||||
10 | be no immunity, under this Act or otherwise, for any person who | ||||||
11 | files a false report or who files a report without good and | ||||||
12 | just cause. Confidentiality of medical information shall be | ||||||
13 | strictly maintained. Investigations that are not referred for | ||||||
14 | prosecution shall be destroyed upon the expiration of the | ||||||
15 | statute of limitations for the acts under investigation | ||||||
16 | immediately expunged and shall not be disclosed except that the | ||||||
17 | employee or employer who was the subject of the report and the | ||||||
18 | person making the report shall be notified that the | ||||||
19 | investigation is being closed , at which time the name of any | ||||||
20 | complainant not connected to the case shall be disclosed to the | ||||||
21 | employee or the employer . It is unlawful for any employer, | ||||||
22 | insurance carrier, or service adjustment company , third party | ||||||
23 | administrator, self-insured, or similar entity to file or | ||||||
24 | threaten to file a report of fraud against an employee because | ||||||
25 | of the exercise by the employee of the rights and remedies | ||||||
26 | granted to the employee by this Act.
|
| |||||||
| |||||||
1 | (e-5) The fraud and insurance non-compliance unit shall | ||||||
2 | procure and implement a system utilizing advanced analytics | ||||||
3 | inclusive of predictive modeling, data mining, social network | ||||||
4 | analysis, and scoring algorithms for the detection and | ||||||
5 | prevention of fraud, waste, and abuse on or before January 1, | ||||||
6 | 2012. The fraud and insurance non-compliance unit shall procure | ||||||
7 | this system using a request for proposals process governed by | ||||||
8 | the Illinois Procurement Code and rules adopted under that | ||||||
9 | Code. The fraud and insurance non-compliance unit shall provide | ||||||
10 | a report to the President of the Senate, Speaker of the House | ||||||
11 | of Representatives, Minority Leader of the House of | ||||||
12 | Representatives, Minority Leader of the Senate, Governor, | ||||||
13 | Chairman of the Commission, and Director of Insurance on or | ||||||
14 | before July 1, 2012 and annually thereafter detailing its | ||||||
15 | activities and providing recommendations regarding | ||||||
16 | opportunities for additional fraud waste and abuse detection | ||||||
17 | and prevention. | ||||||
18 | For purposes of this subsection (e), "employer" means any | ||||||
19 | employer, insurance carrier, third party administrator, | ||||||
20 | self-insured, or similar entity.
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21 | For purposes of this subsection (e), "complainant" refers | ||||||
22 | to the person contacting the fraud and insurance non-compliance | ||||||
23 | unit to initiate the complaint.
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24 | (f) Any person convicted of fraud related to workers' | ||||||
25 | compensation pursuant to this Section shall be subject to the | ||||||
26 | penalties prescribed in the Criminal Code of 1961 and shall be |
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1 | ineligible to receive or retain any compensation, disability, | ||||||
2 | or medical benefits as defined in this Act if the compensation, | ||||||
3 | disability, or medical benefits were owed or received as a | ||||||
4 | result of fraud for which the recipient of the compensation, | ||||||
5 | disability, or medical benefit was convicted. This subsection | ||||||
6 | applies to accidental injuries or diseases that occur on or | ||||||
7 | after the effective date of this amendatory Act of the 94th | ||||||
8 | General Assembly.
| ||||||
9 | (g) Civil liability. Any person convicted of fraud who | ||||||
10 | knowingly obtains, attempts to obtain, or causes to be obtained | ||||||
11 | any benefits under this Act by the making of a false claim or | ||||||
12 | who knowingly misrepresents any material fact shall be civilly | ||||||
13 | liable to the payor of benefits or the insurer or the payor's | ||||||
14 | or insurer's subrogee or assignee in an amount equal to 3 times | ||||||
15 | the value of the benefits or insurance coverage wrongfully | ||||||
16 | obtained or twice the value of the benefits or insurance | ||||||
17 | coverage attempted to be obtained, plus reasonable attorney's | ||||||
18 | fees and expenses incurred by the payor or the payor's subrogee | ||||||
19 | or assignee who successfully brings a claim under this | ||||||
20 | subsection. This subsection applies to accidental injuries or | ||||||
21 | diseases that occur on or after the effective date of this | ||||||
22 | amendatory Act of the 94th General Assembly.
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23 | (h) The All proceedings under this Section shall be | ||||||
24 | reported by the fraud and insurance non-compliance unit shall | ||||||
25 | submit a written report on an annual basis to the Chairman of | ||||||
26 | the Commission, the Workers' Compensation Advisory Board , the |
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1 | General Assembly, the Governor, and the Attorney General by | ||||||
2 | January 1 and July 1 of each year. This report shall include, | ||||||
3 | at the minimum, the following information: | ||||||
4 | (1) The number of allegations of insurance | ||||||
5 | non-compliance and fraud reported to the fraud and | ||||||
6 | insurance non-compliance unit. | ||||||
7 | (2) The source of the reported allegations | ||||||
8 | (individual, employer, or other). | ||||||
9 | (3) The number of allegations investigated by the fraud | ||||||
10 | and insurance non-compliance unit. | ||||||
11 | (4) The number of criminal referrals made in accordance | ||||||
12 | with this Section and the entity to which the referral was | ||||||
13 | made. | ||||||
14 | (5) All proceedings under this Section .
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15 | (Source: P.A. 94-277, eff. 7-20-05.)
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16 | (820 ILCS 305/29.1 new) | ||||||
17 | Sec. 29.1. Recalculation of premiums. On the effective date | ||||||
18 | of this amendatory Act of the 97th General Assembly, the | ||||||
19 | Director of Insurance shall immediately direct in writing any | ||||||
20 | workers' compensation rate setting advisory organization to | ||||||
21 | recalculate workers' compensation advisory premium rates and | ||||||
22 | assigned risk pool premium rates so that those premiums | ||||||
23 | incorporate the provisions of this amendatory Act of the 97th | ||||||
24 | General Assembly, and to publish such rates on or before | ||||||
25 | September 1, 2011.
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1 | (820 ILCS 305/29.2 new) | ||||||
2 | Sec. 29.2. Insurance oversight. | ||||||
3 | (a) The Department of Insurance shall annually submit to | ||||||
4 | the Governor, the Chairman of the Commission, the President of | ||||||
5 | the Senate, the Speaker of the House of Representatives, the | ||||||
6 | Minority Leader of the Senate, and the Minority Leader of the | ||||||
7 | House of Representatives a written report that details the | ||||||
8 | state of the workers' compensation insurance market in | ||||||
9 | Illinois. The report shall be completed by April 1 of each | ||||||
10 | year, beginning in 2012, or later if necessary data or analyses | ||||||
11 | are only available to the Department at a later date. The | ||||||
12 | report shall be posted on the Department of Insurance's | ||||||
13 | Internet website. Information to be included in the report | ||||||
14 | shall be for the preceding calendar year. The report shall | ||||||
15 | include, at a minimum, the following: | ||||||
16 | (1) Gross premiums collected by workers' compensation | ||||||
17 | carriers in Illinois and the national rank of Illinois | ||||||
18 | based on premium volume. | ||||||
19 | (2) The number of insurance companies actively engaged | ||||||
20 | in Illinois in the workers' compensation insurance market, | ||||||
21 | including both holding companies and subsidiaries or | ||||||
22 | affiliates, and the national rank of Illinois based on | ||||||
23 | number of competing insurers. | ||||||
24 | (3) The total number of insured participants in the | ||||||
25 | Illinois workers' compensation assigned risk insurance |
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1 | pool, and the size of the assigned risk pool as a | ||||||
2 | proportion of the total Illinois workers' compensation | ||||||
3 | insurance market. | ||||||
4 | (4) The advisory organization premium rate for | ||||||
5 | workers' compensation insurance in Illinois for the | ||||||
6 | previous year. | ||||||
7 | (5) The advisory organization prescribed assigned risk | ||||||
8 | pool premium rate. | ||||||
9 | (6) The total amount of indemnity payments made by | ||||||
10 | workers' compensation insurers in Illinois. | ||||||
11 | (7) The total amount of medical payments made by | ||||||
12 | workers' compensation insurers in Illinois, and the | ||||||
13 | national rank of Illinois based on average cost of medical | ||||||
14 | claims per injured worker. | ||||||
15 | (8) The gross profitability of workers' compensation | ||||||
16 | insurers in Illinois, and the national rank of Illinois | ||||||
17 | based on profitability of workers' compensation insurers. | ||||||
18 | (9) The loss ratio of workers' compensation insurers in | ||||||
19 | Illinois and the national rank of Illinois based on the | ||||||
20 | loss ratio of workers' compensation insurers. For purposes | ||||||
21 | of this loss ratio calculation, the denominator shall | ||||||
22 | include all premiums and other fees collected by workers' | ||||||
23 | compensation insurers and the numerator shall include the | ||||||
24 | total amount paid by the insurer for care or compensation | ||||||
25 | to injured workers. | ||||||
26 | (10) The growth of total paid indemnity benefits by |
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1 | temporary total disability, scheduled and non-scheduled | ||||||
2 | permanent partial disability, and total disability. | ||||||
3 | (11) The number of injured workers receiving wage loss | ||||||
4 | differential awards and the average wage loss differential | ||||||
5 | award payout. | ||||||
6 | (12) Illinois' rank, relative to other states, for: | ||||||
7 | (i) the maximum and minimum temporary total | ||||||
8 | disability benefit level; | ||||||
9 | (ii) the maximum and minimum scheduled and | ||||||
10 | non-scheduled permanent partial disability benefit | ||||||
11 | level; | ||||||
12 | (iii) the maximum and minimum total disability | ||||||
13 | benefit level; and | ||||||
14 | (iv) the maximum and minimum death benefit level. | ||||||
15 | (13) The aggregate growth of medical benefit payout by | ||||||
16 | non-hospital providers and hospitals. | ||||||
17 | (14) The aggregate growth of medical utilization for | ||||||
18 | the top 10 most common injuries to specific body parts by | ||||||
19 | non-hospital providers and hospitals. | ||||||
20 | (15) The percentage of injured workers filing claims at | ||||||
21 | the Commission that are represented by an attorney. | ||||||
22 | (16) The total amount paid by injured workers for | ||||||
23 | attorney representation. | ||||||
24 | (b) The Director of Insurance shall promulgate rules | ||||||
25 | requiring each insurer licensed to write workers' compensation | ||||||
26 | coverage in the State to record and report the following |
| |||||||
| |||||||
1 | information on an aggregate basis to the Department of | ||||||
2 | Insurance before March 1 of each year, relating to claims in | ||||||
3 | the State opened within the prior calendar year: | ||||||
4 | (1) The number of claims opened. | ||||||
5 | (2) The number of reported medical only claims. | ||||||
6 | (3) The number of contested claims. | ||||||
7 | (4) The number of claims for which the employee has | ||||||
8 | attorney representation. | ||||||
9 | (5) The number of claims with lost time and the number | ||||||
10 | of claims for which temporary total disability was paid. | ||||||
11 | (6) The number of claim adjusters employed to adjust | ||||||
12 | workers' compensation claims. | ||||||
13 | (7) The number of claims for which temporary total | ||||||
14 | disability was not paid within 14 days from the first full | ||||||
15 | day off, regardless of reason. | ||||||
16 | (8) The number of medical bills paid 60 days or later | ||||||
17 | from date of service and the average days paid on those | ||||||
18 | paid after 60 days for the previous calendar year. | ||||||
19 | (9) The number of claims in which in-house defense | ||||||
20 | counsel participated, and the total amount spent on | ||||||
21 | in-house legal services. | ||||||
22 | (10) The number of claims in which outside defense | ||||||
23 | counsel participated, and the total amount paid to outside | ||||||
24 | defense counsel. | ||||||
25 | (11) The total amount billed to employers for bill | ||||||
26 | review. |
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| |||||||
1 | (12) The total amount billed to employers for fee | ||||||
2 | schedule savings. | ||||||
3 | (13) The total amount charged to employers for any and | ||||||
4 | all managed care fees. | ||||||
5 | (14) The number of claims involving in-house medical | ||||||
6 | nurse case management, and the total amount spent on | ||||||
7 | in-house medical nurse case management. | ||||||
8 | (15) The number of claims involving outside medical | ||||||
9 | nurse case management, and the total amount paid for | ||||||
10 | outside medical nurse case management. | ||||||
11 | (16) The total amount paid for Independent Medical | ||||||
12 | exams. | ||||||
13 | (17) The total amount spent on in-house Utilization | ||||||
14 | Review for the previous calendar year. | ||||||
15 | (18) The total amount paid for outside Utilization | ||||||
16 | Review for the previous calendar year. | ||||||
17 | The Department shall make the submitted information | ||||||
18 | publicly available on the Department's Internet website or such | ||||||
19 | other media as appropriate in a form useful for consumers.
| ||||||
20 | Section 97. Severability. The provisions of this Act are | ||||||
21 | severable under Section 1.31 of the Statute on Statutes.
| ||||||
22 | Section 99. Effective date. This Act takes effect upon | ||||||
23 | becoming law.
|