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