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Public Act 102-0775 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Motor Vehicle Theft Prevention and | ||||
Insurance Verification Act is amended by changing Sections 8.5 | ||||
and 8.6 as follows: | ||||
(20 ILCS 4005/8.5) | ||||
(Section scheduled to be repealed on January 1, 2025) | ||||
Sec. 8.5. State Police Motor Vehicle Theft Prevention | ||||
Trust Fund. The State Police Motor Vehicle Theft Prevention | ||||
Trust Fund is created as a trust fund in the State treasury. | ||||
The State Treasurer shall be the custodian of the Trust Fund. | ||||
The State Police Motor Vehicle Theft Prevention Trust Fund is | ||||
established to receive funds from the Illinois Motor Vehicle | ||||
Theft Prevention and Insurance Verification Council. All | ||||
interest earned from the investment or deposit of moneys | ||||
accumulated in the Trust Fund shall be deposited into the | ||||
Trust Fund. Moneys in the Trust Fund shall be used by the | ||||
Illinois State Police for motor vehicle theft prevention | ||||
purposes.
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(Source: P.A. 102-538, eff. 8-20-21.) | ||||
(20 ILCS 4005/8.6) |
Sec. 8.6. State Police Training and Academy Fund; Law | ||
Enforcement Training Fund. Before April 1 of each year, each | ||
insurer engaged in writing private passenger motor vehicle | ||
insurance coverage that is included in Class 2 and Class 3 of | ||
Section 4 of the Illinois Insurance Code, as a condition of its | ||
authority to transact business in this State, may collect and | ||
shall pay shall collect and remit to the Department of | ||
Insurance an amount equal to $4, or a lesser amount determined | ||
by the Illinois Law Enforcement Training Board by rule, | ||
multiplied by the insurer's total earned car years of private | ||
passenger motor vehicle insurance policies providing physical | ||
damage insurance coverage written in this State during the | ||
preceding calendar year. Of the amounts collected under this | ||
Section, the Department of Insurance shall deposit 10% into | ||
the State Police Training and Academy Fund and 90% into the Law | ||
Enforcement Training Fund.
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(Source: P.A. 102-16, eff. 6-17-21.) | ||
Section 10. The Illinois Insurance Code is amended by | ||
changing Sections 35B-30, 143, 143a, 229.4a, 353a, 355a, 408, | ||
412, and 416 and by adding Section 355c as follows: | ||
(215 ILCS 5/35B-30) | ||
Sec. 35B-30. Certificate of division. | ||
(a) After a plan of division has been adopted and | ||
approved, an officer or duly authorized representative of the |
dividing company shall sign a certificate of division. | ||
(b) The certificate of division shall set forth: | ||
(1) the name of the dividing company; | ||
(2) a statement disclosing whether the dividing | ||
company will survive the division; | ||
(3) the name of each new company that will be created | ||
by the division; | ||
(4) the kinds of insurance business enumerated in | ||
Section 4 that the new company will be authorized to | ||
conduct; | ||
(5) the date that the division is to be effective, | ||
which shall not be more than 90 days after the dividing | ||
company has filed the certificate of division with the | ||
recorder, with a concurrent copy to the Director; | ||
(6) a statement that the division was approved by the | ||
Director in accordance with Section 35B-25; | ||
(7) (6) a statement that the dividing company | ||
provided, no later than 10 business days after the | ||
dividing company filed the plan of division with the | ||
Director, reasonable notice to each reinsurer that is | ||
party to a reinsurance contract that is applicable to the | ||
policies included in the plan of division; | ||
(8) (7) if the dividing company will survive the | ||
division, an amendment to its articles of incorporation or | ||
bylaws approved as part of the plan of division; | ||
(9) (8) for each new company created by the division, |
its articles of incorporation and bylaws, provided that | ||
the articles of incorporation and bylaws need not state | ||
the name or address of an incorporator; and | ||
(10) (9) a reasonable description of the capital, | ||
surplus, other assets and liabilities, including policy | ||
liabilities, of the dividing company that are to be | ||
allocated to each resulting company. | ||
(c) The articles of incorporation and bylaws of each new | ||
company must satisfy the requirements of the laws of this | ||
State, provided that the documents need not be signed or | ||
include a provision that need not be included in a restatement | ||
of the document. | ||
(d) A certificate of division is effective when filed with | ||
the recorder, with a concurrent copy to the Director, as | ||
provided in this Section or on another date specified in the | ||
plan of division, whichever is later, provided that a | ||
certificate of division shall become effective not more than | ||
90 days after it is filed with the recorder. A division is | ||
effective when the relevant certificate of division is | ||
effective.
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(Source: P.A. 100-1118, eff. 11-27-18.)
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(215 ILCS 5/143) (from Ch. 73, par. 755)
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Sec. 143. Policy forms.
| ||
(1) Life, accident and health. No company
transacting the | ||
kind or kinds of business enumerated in Classes 1 (a), 1
(b) |
and 2 (a) of Section 4 shall issue or deliver in this State a | ||
policy
or certificate of insurance or evidence of coverage, | ||
attach an
endorsement or rider thereto,
incorporate by | ||
reference bylaws or other matter therein or use an
application | ||
blank in this State until the form and content of such
policy, | ||
certificate, evidence of coverage, endorsement, rider, bylaw | ||
or
other matter
incorporated by reference or application blank | ||
has been filed electronically
with the Director, either | ||
through the System for Electronic Rate and Form Filing (SERFF) | ||
or as otherwise prescribed by the Director, and
approved by | ||
the Director. Any such endorsement or rider
that unilaterally | ||
reduces benefits and is to be attached to a
policy subsequent | ||
to the date the policy is
issued must be filed with, reviewed, | ||
and formally approved by the
Director prior to the date it is | ||
attached to a policy issued or
delivered in this State. It | ||
shall be the duty of the Director to disapprove or withdraw
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withhold approval of any such policy, certificate, | ||
endorsement, rider,
bylaw or other matter incorporated by | ||
reference or application blank
filed with him if it contains | ||
deficiencies, provisions which encourage
misrepresentation or | ||
are unjust, unfair, inequitable, ambiguous,
misleading, | ||
inconsistent, deceptive, contrary to law or to the public
| ||
policy of this State, or contains exceptions and conditions | ||
that
unreasonably or deceptively affect the risk purported to | ||
be assumed in
the general coverage of the policy. In all cases | ||
the Director shall
approve , withdraw, or disapprove any such |
form within 60 days after submission
unless the Director | ||
extends by not more than an additional 30 days the
period | ||
within which the he shall approve or disapprove any such form | ||
shall be approved, withdrawn, or disapproved by
giving written | ||
notice to the insurer of such extension before expiration
of | ||
the initial 60 days period. The Director shall withdraw his | ||
approval
of a policy, certificate, evidence of coverage, | ||
endorsement, rider,
bylaw, or other matter incorporated
by | ||
reference or application blank if it is subsequently | ||
determined he subsequently determines that such
policy, | ||
certificate, evidence of coverage, endorsement, rider, bylaw,
| ||
other matter, or application
blank is misrepresentative, | ||
unjust, unfair, inequitable, ambiguous, misleading,
| ||
inconsistent, deceptive, contrary to law or public policy of | ||
this State,
or contains exceptions or conditions which | ||
unreasonably or deceptively affect
the risk purported to be | ||
assumed in the general coverage of the policy or
evidence of | ||
coverage.
| ||
If a previously approved policy, certificate, evidence of
| ||
coverage, endorsement, rider, bylaw
or other matter | ||
incorporated by reference or application blank is withdrawn
| ||
for use, the Director shall serve upon the company an order of | ||
withdrawal
of use, either personally or by mail, and if by | ||
mail, such service shall
be completed if such notice be | ||
deposited in the post office, postage prepaid,
addressed to | ||
the company's last known address specified in the records
of |
the Department of Insurance. The order of withdrawal of use | ||
shall take
effect 30 days from the date of mailing but shall be | ||
stayed if within the
30-day period a written request for | ||
hearing is filed with the Director.
Such hearing shall be held | ||
at such time and place as designated in the order
given by the | ||
Director. The hearing may be held either in the City of | ||
Springfield,
the City of Chicago or in the county where the | ||
principal business address
of the company is located.
The | ||
action of the Director in
disapproving or withdrawing such | ||
form shall be subject to judicial review under
the
| ||
Administrative Review Law.
| ||
This subsection shall not apply to riders or endorsements | ||
issued or
made at the request of the individual policyholder | ||
relating to the
manner of distribution of benefits or to the | ||
reservation of rights and
benefits under his life insurance | ||
policy.
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(2) Casualty, fire, and marine. The Director shall require | ||
the
filing of all policy forms issued or delivered by any | ||
company transacting
the kind or
kinds of business enumerated | ||
in Classes 2 (except Class 2 (a)) and 3 of
Section 4 in an | ||
electronic format either through the System for Electronic | ||
Rate and Form Filing (SERFF) or as otherwise prescribed and | ||
approved by the Director. In addition, he may require the | ||
filing of any
generally used riders, endorsements, | ||
certificates, application blanks, and
other matter
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incorporated by reference in any such policy or contract of |
insurance.
Companies that are members of an organization, | ||
bureau, or association may
have the same filed for them by the | ||
organization, bureau, or association. If
the Director shall | ||
find from an examination of any such policy form,
rider, | ||
endorsement, certificate, application blank, or other matter
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incorporated by
reference in any such policy so filed that it | ||
(i) violates any provision of
this Code, (ii) contains | ||
inconsistent, ambiguous, or misleading clauses, or
(iii) | ||
contains exceptions and conditions that will unreasonably or | ||
deceptively
affect the risks that are purported to be assumed | ||
by the policy, he
shall order the company or companies issuing | ||
these forms to discontinue
their use. Nothing in this | ||
subsection shall require a company
transacting the kind or | ||
kinds of business enumerated in Classes 2
(except Class 2 (a)) | ||
and 3 of Section 4 to obtain approval of these forms
before | ||
they are issued nor in any way affect the legality of any
| ||
policy that has been issued and found to be in conflict with | ||
this
subsection, but such policies shall be subject to the | ||
provisions of
Section 442.
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(3) This Section shall not apply (i) to surety contracts | ||
or fidelity
bonds, (ii) to policies issued to an industrial | ||
insured as defined in Section
121-2.08 except for workers' | ||
compensation policies, nor (iii) to riders
or
endorsements | ||
prepared to meet special, unusual,
peculiar, or extraordinary | ||
conditions applying to an individual risk.
| ||
(Source: P.A. 97-486, eff. 1-1-12; 98-226, eff. 1-1-14.)
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(215 ILCS 5/143a) (from Ch. 73, par. 755a)
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Sec. 143a. Uninsured and hit and run motor vehicle | ||
coverage.
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(1) No policy insuring against
loss resulting from | ||
liability imposed by law for bodily injury or death
suffered | ||
by any person arising out of the ownership, maintenance or use
| ||
of a motor vehicle that is designed for use on public highways | ||
and that
is either required to be registered in this State or | ||
is principally garaged
in this State shall be renewed, | ||
delivered, or issued for delivery
in this State unless | ||
coverage is provided therein or
supplemental thereto, in | ||
limits for bodily injury or death set forth in
Section 7-203 of | ||
the Illinois Vehicle Code for the
protection of persons | ||
insured thereunder who are legally entitled to
recover damages | ||
from owners or operators of uninsured motor vehicles and
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hit-and-run motor vehicles because of bodily injury, sickness | ||
or
disease, including death, resulting therefrom. Uninsured | ||
motor vehicle
coverage does not apply to bodily injury, | ||
sickness, disease, or death resulting
therefrom, of an insured | ||
while occupying a motor vehicle owned by, or furnished
or | ||
available for the regular use of the insured, a resident | ||
spouse or resident
relative, if that motor vehicle is not | ||
described in the policy under which a
claim is made or is not a | ||
newly acquired or replacement motor vehicle covered
under the | ||
terms of the policy. The limits for any coverage for any |
vehicle
under the policy may not be aggregated with the limits | ||
for any similar
coverage, whether provided by the same insurer | ||
or another insurer, applying to
other motor vehicles, for | ||
purposes of determining the total limit of insurance
coverage | ||
available for bodily injury or death suffered by a person in | ||
any one
accident. No
policy shall be renewed, delivered, or | ||
issued for delivery in this
State unless it is provided | ||
therein that any dispute
with respect to the coverage and the | ||
amount of damages shall be submitted
for arbitration to the
| ||
American Arbitration Association and be subject to its rules | ||
for the conduct
of arbitration hearings
as to all matters | ||
except medical opinions. As to medical opinions, if the
amount | ||
of damages being sought is equal to or less than the amount | ||
provided for
in Section 7-203 of the Illinois Vehicle Code, | ||
then the current American
Arbitration Association Rules shall | ||
apply. If the amount being sought in an
American Arbitration | ||
Association case exceeds that amount as set forth in
Section | ||
7-203 of the Illinois Vehicle Code, then the Rules of Evidence | ||
that
apply in the circuit court for placing medical opinions | ||
into evidence shall
govern. Alternatively, disputes with | ||
respect to damages and the coverage shall
be
determined in the
| ||
following
manner: Upon the insured requesting arbitration, | ||
each party to the
dispute shall select an arbitrator and the 2 | ||
arbitrators so named
shall select a third arbitrator. If such | ||
arbitrators are not selected
within 45 days from such request, | ||
either party may request that the
arbitration be submitted to |
the American Arbitration Association.
Any decision made by the | ||
arbitrators shall be binding for the amount of
damages not | ||
exceeding $75,000 for bodily injury to or
death of any one | ||
person, $150,000 for bodily injury to or death of 2 or more
| ||
persons in any one motor vehicle accident,
or the | ||
corresponding policy limits for bodily injury or death, | ||
whichever is
less.
All 3-person arbitration cases proceeding | ||
in accordance with any uninsured
motorist
coverage conducted | ||
in this State in
which the claimant is only seeking monetary | ||
damages up to the limits
set forth in Section 7-203 of the | ||
Illinois Vehicle Code
shall be subject to the following rules:
| ||
(A) If at least 60 days' written
notice of the | ||
intention to offer the following documents in evidence is | ||
given
to every other party, accompanied by a copy of the | ||
document, a party may offer
in evidence, without | ||
foundation or other proof:
| ||
(1) bills, records, and reports of hospitals, | ||
doctors, dentists,
registered nurses, licensed | ||
practical nurses, physical therapists, and other
| ||
healthcare providers;
| ||
(2) bills for drugs, medical appliances, and | ||
prostheses;
| ||
(3) property repair bills or estimates, when | ||
identified and itemized
setting forth the charges for | ||
labor and material used or proposed for use in
the | ||
repair of the property;
|
(4) a report of the rate of earnings and time lost | ||
from work or lost
compensation prepared by an | ||
employer;
| ||
(5) the written opinion of an opinion witness, the | ||
deposition of a
witness, and the statement of a | ||
witness that the witness would be allowed to
express | ||
if testifying in person, if the opinion or statement | ||
is made by
affidavit or by
certification as provided | ||
in Section 1-109 of the Code of Civil Procedure;
| ||
(6) any other document not specifically covered by | ||
any of the foregoing
provisions that is otherwise | ||
admissible under the rules of evidence.
| ||
Any party receiving a notice under this paragraph (A) | ||
may apply to the
arbitrator or panel of arbitrators, as | ||
the case may be, for the issuance of a
subpoena directed to | ||
the author or maker or custodian of the document that is
| ||
the subject of the notice, requiring the person subpoenaed | ||
to produce copies of
any additional documents as may be | ||
related to the subject matter of the
document that is the | ||
subject of the notice. Any such subpoena shall be issued
| ||
in substantially similar form and served by notice as | ||
provided by Illinois
Supreme Court Rule 204(a)(4). Any | ||
such subpoena shall be returnable not
less than 5 days | ||
before the arbitration hearing.
| ||
(B) Notwithstanding the provisions of Supreme Court | ||
Rule 213(g), a party
who proposes to use a written opinion |
of an expert or opinion witness or the
testimony of
an | ||
expert or opinion witness at the hearing may do so | ||
provided a written notice
of that
intention is given to | ||
every other party not less than 60 days prior to the date
| ||
of hearing, accompanied by a statement containing the | ||
identity of the
witness, his or her qualifications, the | ||
subject matter, the basis of the
witness's conclusions,
| ||
and his or her opinion.
| ||
(C) Any other party may subpoena the author or maker | ||
of a document
admissible under this subsection, at that | ||
party's expense, and examine the
author
or maker as if | ||
under cross-examination. The provisions of Section 2-1101 | ||
of
the
Code of Civil Procedure shall be applicable to | ||
arbitration hearings, and it
shall be the duty of a party | ||
requesting the subpoena to modify the form to show
that | ||
the appearance is set before an arbitration panel and to | ||
give the time and
place set for the hearing.
| ||
(D) The provisions of Section 2-1102 of the Code of | ||
Civil Procedure shall
be
applicable to arbitration | ||
hearings under this subsection.
| ||
(2) No policy insuring
against loss resulting from | ||
liability imposed by law for property damage
arising out of | ||
the ownership, maintenance, or use of a motor vehicle shall
be | ||
renewed, delivered, or issued for delivery in this State with | ||
respect
to any private passenger or recreational motor vehicle | ||
that is
designed for use on public highways and that is either |
required to be
registered in this State or is principally | ||
garaged in this State and
is not covered by collision | ||
insurance under the provisions of such
policy , unless coverage | ||
is made available in the amount of the actual
cash value of the | ||
motor vehicle described in the policy or the corresponding | ||
policy limit for uninsured motor vehicle property damage | ||
coverage, $15,000
whichever is less, subject to a maximum $250 | ||
deductible, for the protection of
persons insured thereunder | ||
who are legally entitled to recover damages from
owners or | ||
operators of uninsured motor vehicles and hit-and-run motor
| ||
vehicles because of property damage to the motor vehicle | ||
described in the
policy.
| ||
There shall be no liability imposed under the uninsured | ||
motorist
property damage coverage required by this subsection | ||
if the owner or
operator of the at-fault uninsured motor | ||
vehicle or hit-and-run motor
vehicle cannot be identified. | ||
This subsection shall not apply to any
policy which does not | ||
provide primary motor vehicle liability insurance for
| ||
liabilities arising from the maintenance, operation, or use of | ||
a
specifically insured motor vehicle.
| ||
Each insurance company providing motor vehicle property | ||
damage liability
insurance shall advise applicants of the | ||
availability of uninsured motor
vehicle property damage | ||
coverage, the premium therefor, and provide a brief
| ||
description of the coverage. That information
need be given | ||
only once and shall not be required in any subsequent renewal,
|
reinstatement or reissuance, substitute, amended, replacement | ||
or
supplementary policy. No written rejection shall be | ||
required, and
the absence of a premium payment for uninsured | ||
motor vehicle property damage
shall constitute conclusive | ||
proof that the applicant or policyholder has
elected not to | ||
accept uninsured motorist property damage coverage.
| ||
An insurance company issuing uninsured motor vehicle
| ||
property damage coverage may provide that:
| ||
(i) Property damage losses recoverable thereunder | ||
shall be limited to
damages caused by the actual physical | ||
contact of an uninsured motor vehicle
with the insured | ||
motor vehicle.
| ||
(ii) There shall be no coverage for loss of use of the | ||
insured motor
vehicle and no coverage for loss or damage | ||
to personal property located in
the insured motor vehicle.
| ||
(iii) Any claim submitted shall include the name and | ||
address of the
owner of the at-fault uninsured motor | ||
vehicle, or a registration number and
description of the | ||
vehicle, or any other available information to
establish | ||
that there is no applicable motor vehicle property damage | ||
liability
insurance.
| ||
Any dispute with respect to the coverage and the amount of
| ||
damages shall be submitted for
arbitration to the American | ||
Arbitration Association and be subject to its
rules for the | ||
conduct of arbitration hearings or for determination in
the | ||
following manner: Upon the insured requesting arbitration, |
each party
to the dispute shall select an arbitrator and the 2 | ||
arbitrators so named
shall select a third arbitrator. If such | ||
arbitrators are not selected
within 45 days from such request, | ||
either party may request that the
arbitration be submitted to | ||
the American Arbitration Association.
Any arbitration | ||
proceeding under this subsection seeking recovery for
property | ||
damages shall be
subject to the following rules:
| ||
(A) If at least 60 days' written
notice of the | ||
intention to offer the following documents in evidence is | ||
given
to every other party, accompanied by a copy of the | ||
document, a party may offer
in evidence, without | ||
foundation or other proof:
| ||
(1) property repair bills or estimates, when | ||
identified and itemized
setting forth the charges for | ||
labor and material used or proposed for use in
the | ||
repair of the property;
| ||
(2) the written opinion of an opinion witness, the | ||
deposition of a
witness, and the statement of a | ||
witness that the witness would be allowed to
express | ||
if testifying in person, if the opinion or statement | ||
is made by
affidavit or by
certification as provided | ||
in Section 1-109 of the Code of Civil Procedure;
| ||
(3) any other document not specifically covered by | ||
any of the foregoing
provisions that is otherwise | ||
admissible under the rules of evidence.
| ||
Any party receiving a notice under this paragraph (A) |
may apply to the
arbitrator or panel of arbitrators, as | ||
the case may be, for the issuance of a
subpoena directed to | ||
the author or maker or custodian of the document that is
| ||
the subject of the notice, requiring the person subpoenaed | ||
to produce copies of
any additional documents as may be | ||
related to the subject matter of the
document that is the | ||
subject of the notice. Any such subpoena shall be issued
| ||
in substantially similar form and served by notice as | ||
provided by Illinois
Supreme Court Rule 204(a)(4). Any | ||
such subpoena shall be returnable not
less than 5 days | ||
before the arbitration hearing.
| ||
(B) Notwithstanding the provisions of Supreme Court | ||
Rule 213(g), a party
who proposes to use a written opinion | ||
of an expert or opinion witness or the
testimony of
an | ||
expert or opinion witness at the hearing may do so | ||
provided a written notice
of that
intention is given to | ||
every other party not less than 60 days prior to the date
| ||
of hearing, accompanied by a statement containing the | ||
identity of the
witness, his or her qualifications, the | ||
subject matter, the basis of the
witness's conclusions,
| ||
and his or her opinion.
| ||
(C) Any other party may subpoena the author or maker | ||
of a document
admissible under this subsection, at that | ||
party's expense, and examine the
author
or maker as if | ||
under cross-examination. The provisions of Section 2-1101 | ||
of
the
Code of Civil Procedure shall be applicable to |
arbitration hearings, and it
shall be the duty of a party | ||
requesting the subpoena to modify the form to show
that | ||
the appearance is set before an arbitration panel and to | ||
give the time and
place set for the hearing.
| ||
(D) The provisions of Section 2-1102 of the Code of | ||
Civil Procedure shall
be
applicable to arbitration | ||
hearings under this subsection.
| ||
(3) For the purpose of the coverage, the term "uninsured | ||
motor
vehicle" includes, subject to the terms and conditions | ||
of the coverage,
a motor vehicle where on, before or after the | ||
accident date the
liability insurer thereof is unable to make | ||
payment with respect to the
legal liability of its insured | ||
within the limits specified in the policy
because of the entry | ||
by a court of competent jurisdiction of an order of
| ||
rehabilitation or liquidation by reason of insolvency on or | ||
after the
accident date. An insurer's extension of coverage, | ||
as provided in this
subsection, shall be applicable to all | ||
accidents occurring after July
1, 1967 during a policy period | ||
in which its insured's uninsured motor
vehicle coverage is in | ||
effect. Nothing in this Section may be construed
to prevent | ||
any insurer from extending coverage under terms and
conditions | ||
more favorable to its insureds than is required by this | ||
Section.
| ||
(4) In the event of payment to any person under the | ||
coverage
required by this Section and subject to the terms and | ||
conditions of the
coverage, the insurer making the payment |
shall, to the extent thereof,
be entitled to the proceeds of | ||
any settlement or judgment resulting from
the exercise of any | ||
rights of recovery of the person against any person
or | ||
organization legally responsible for the property damage, | ||
bodily
injury or death for which the payment is made, | ||
including the proceeds
recoverable from the assets of the | ||
insolvent insurer. With respect to
payments made by reason of | ||
the coverage described in subsection (3), the
insurer making | ||
such payment shall not be entitled to any right of recovery
| ||
against the tortfeasor in excess of the proceeds recovered | ||
from the assets
of the insolvent insurer of the tortfeasor.
| ||
(5) This amendatory Act of 1967 (Laws of Illinois 1967, | ||
page 875) shall not be construed to terminate
or reduce any | ||
insurance coverage or any right of any party under this
Code in | ||
effect before July 1, 1967. Public Act 86-1155 shall not
be | ||
construed to terminate or reduce any insurance coverage or any | ||
right of
any party under this Code in effect before its | ||
effective date.
| ||
(6) Failure of the motorist from whom the claimant is | ||
legally
entitled to recover damages to file the appropriate | ||
forms with the
Safety Responsibility Section of the Department | ||
of Transportation within
120 days of the accident date shall | ||
create a rebuttable presumption that
the motorist was | ||
uninsured at the time of the injurious occurrence.
| ||
(7) An insurance carrier may upon good cause require the
| ||
insured to commence a legal action against the owner or |
operator of an
uninsured motor vehicle before good faith | ||
negotiation with the carrier. If
the action is commenced at | ||
the request of the insurance carrier, the
carrier shall pay to | ||
the insured, before the action is commenced, all court
costs, | ||
jury fees and sheriff's fees arising from the action.
| ||
The changes made by Public Act 90-451 apply to all | ||
policies of
insurance amended, delivered, issued, or renewed | ||
on and after January 1, 1998 (the effective
date of Public Act | ||
90-451).
| ||
(8) The changes made by Public Act 98-927 apply to all | ||
policies of
insurance amended, delivered, issued, or renewed | ||
on and after January 1, 2015 (the effective
date of Public Act | ||
98-927). | ||
(Source: P.A. 98-242, eff. 1-1-14; 98-927, eff. 1-1-15; | ||
99-642, eff. 7-28-16.)
| ||
(215 ILCS 5/229.4a)
| ||
Sec. 229.4a. Standard Non-forfeiture Law for Individual | ||
Deferred
Annuities. | ||
(1)
Title.
This Section shall be known as the Standard | ||
Nonforfeiture Law for Individual Deferred Annuities. | ||
(2) Applicability.
This Section shall not apply to any | ||
reinsurance, group annuity purchased under a retirement plan | ||
or plan of deferred compensation established or maintained by | ||
an employer (including a partnership or sole proprietorship) | ||
or by an employee organization, or by both, other than a plan |
providing individual retirement accounts or individual | ||
retirement annuities under Section 408 of the Internal Revenue | ||
Code, as now or hereafter amended, premium deposit fund, | ||
variable annuity, investment annuity, immediate annuity, any | ||
deferred annuity contract after annuity payments have | ||
commenced, or reversionary annuity, nor to any contract which | ||
shall be delivered outside this State through an agent or | ||
other representative of the company issuing the contract. | ||
(3) Nonforfeiture Requirements. | ||
(A) In the case of contracts issued on or after the | ||
operative date of this Section
as defined in subsection | ||
(13), no contract of annuity, except as stated in | ||
subsection (2), shall be delivered or issued for delivery | ||
in this State unless it contains in substance the | ||
following provisions, or corresponding provisions which in | ||
the opinion of the Director of Insurance are at least as | ||
favorable to the contract holder, upon cessation of | ||
payment of considerations under the contract: | ||
(i) That upon cessation of payment of | ||
considerations under a contract, or upon the written | ||
request of the contract owner, the company shall grant | ||
a paid-up annuity benefit on a plan stipulated in the | ||
contract of such value as is specified in subsections | ||
(5), (6), (7), (8) and (10); | ||
(ii)
If a contract provides for a lump sum | ||
settlement at maturity, or at any other time, that |
upon surrender of the contract at or prior to the | ||
commencement of any annuity payments, the company | ||
shall pay in lieu of a paid-up annuity benefit a cash | ||
surrender benefit of such amount as is
specified in | ||
subsections (5), (6), (8) and (10). The company may | ||
reserve the right to
defer the payment of the cash | ||
surrender benefit for a period not to exceed 6 months | ||
after demand therefor with surrender of the contract | ||
after making written request and receiving written | ||
approval of the Director. The request shall address | ||
the necessity and equitability to all policyholders of | ||
the deferral; | ||
(iii) A statement of the mortality table, if any, | ||
and interest rates used calculating any minimum | ||
paid-up annuity, cash surrender, or death benefits | ||
that are guaranteed under the contract, together with | ||
sufficient information to determine the amounts of the | ||
benefits; and | ||
(iv)
A statement that any paid-up annuity, cash | ||
surrender or death benefits that may be available | ||
under the contract are not less than the minimum | ||
benefits required by any statute of the state in which | ||
the contract is delivered and an explanation of the | ||
manner in which the benefits are altered by the | ||
existence of any additional amounts credited by the | ||
company to the contract, any indebtedness to the |
company on the contract or any prior withdrawals from | ||
or partial surrenders of the contract. | ||
(B) Notwithstanding the requirements of this Section, | ||
a deferred annuity contract may provide that if no | ||
considerations have been received under a contract for a | ||
period of 2 full years and the portion of the paid-up | ||
annuity benefit at maturity on the plan stipulated in the | ||
contract arising from prior considerations paid would be | ||
less than $20 monthly, the company may at its option | ||
terminate the contract by payment in cash of the then | ||
present value of the portion of the paid-up annuity | ||
benefit, calculated on the basis on the mortality table, | ||
if any, and interest rate specified in the contract for | ||
determining the paid-up annuity benefit, and by this | ||
payment shall be relieved of any further obligation under | ||
the contract. | ||
(4) Minimum values. The minimum values as specified in | ||
subsections (5), (6), (7), (8) and (10) of any paid-up | ||
annuity, cash surrender or death benefits available under an | ||
annuity contract shall be based upon minimum nonforfeiture | ||
amounts as defined in this subsection.
| ||
(A)(i) The minimum nonforfeiture amount at any time at | ||
or prior to the commencement of any annuity payments shall | ||
be equal to an accumulation up to such time at rates of | ||
interest as indicated in subdivision (4)(B) of the net | ||
considerations (as hereinafter defined) paid prior to such |
time, decreased by the sum of paragraphs (a) through (d) | ||
below: | ||
(a) Any prior withdrawals from or partial | ||
surrenders of the contract accumulated at rates of | ||
interest as indicated in subdivision (4)(B);
| ||
(b) An annual contract charge of $50, accumulated | ||
at rates of interest as indicated in subdivision | ||
(4)(B);
| ||
(c) Any premium tax paid by the company for the | ||
contract, accumulated at rates of interest as | ||
indicated in subdivision (4)(B); and
| ||
(d) The amount of any indebtedness to the company | ||
on the contract, including
interest due and accrued. | ||
(ii) The net considerations for a given contract year | ||
used to define the minimum nonforfeiture amount shall be | ||
an amount
equal to 87.5% of the gross considerations,
| ||
credited to the contract during that contract year. | ||
(B) The interest rate used in determining minimum | ||
nonforfeiture amounts shall be an
annual rate of interest | ||
determined as the lesser of 3% per annum
and the | ||
following, which shall be specified in the contract if the | ||
interest rate will be reset: | ||
(i) The five-year Constant Maturity Treasury Rate | ||
reported by the Federal Reserve as of a date, or | ||
average over a period, rounded to the nearest 1/20th | ||
of one percent, specified in the contract no longer |
than 15 months prior to the contract issue date or | ||
redetermination date under subdivision (4)(B)(iv); | ||
(ii) Reduced by 125 basis points; | ||
(iii) Where the resulting interest rate is not | ||
less than 0.15% 1% ; and | ||
(iv) The interest rate shall apply for an initial | ||
period and may be redetermined for additional periods. | ||
The redetermination date, basis and period, if any, | ||
shall be stated in the contract. The basis is the date | ||
or average over a specified period that produces the | ||
value of the 5-year Constant Maturity Treasury Rate to | ||
be used at each redetermination date. | ||
(C) During the period or term that a contract provides | ||
substantive participation in an equity indexed benefit, it | ||
may increase the reduction described in subdivision | ||
(4)(B)(ii)
above by up to an additional 100 basis points | ||
to reflect the value of the equity
index benefit. The | ||
present value at the contract issue date, and at each
| ||
redetermination date thereafter, of the additional | ||
reduction shall not exceed market value of the benefit. | ||
The Director may require a demonstration that the present | ||
value of the additional reduction does not exceed the | ||
market value of the benefit. Lacking such a demonstration | ||
that is acceptable to the Director, the Director may | ||
disallow or limit the additional reduction. | ||
(D) The Director may adopt rules to implement the |
provisions of subdivision (4)(C) and to provide for | ||
further adjustments to the calculation of minimum | ||
nonforfeiture amounts for contracts that provide | ||
substantive participation in an equity index benefit and | ||
for other contracts that the Director determines | ||
adjustments are justified. | ||
(5) Computation of Present Value.
Any paid-up annuity | ||
benefit available under a contract shall be such that its | ||
present value on the date annuity payments are to commence is | ||
at least equal to the minimum nonforfeiture amount on that | ||
date. Present value shall be computed using the mortality | ||
table, if any, and the interest rates specified in the | ||
contract for determining the minimum paid-up annuity benefits | ||
guaranteed in the contract. | ||
(6) Calculation of Cash Surrender Value.
For contracts | ||
that provide cash surrender benefits, the cash surrender | ||
benefits available prior to maturity shall not be less than | ||
the present value as of the date of surrender of that portion | ||
of the maturity value of the paid-up annuity benefit that | ||
would be provided under the contract at maturity arising from | ||
considerations paid prior to the time of cash surrender | ||
reduced by the amount appropriate to reflect any prior | ||
withdrawals from or partial surrenders of the contract, such | ||
present value being calculated on the basis of an interest | ||
rate not more than 1% higher than the interest rate specified | ||
in the contract for accumulating the net considerations to |
determine maturity value, decreased by the amount of any | ||
indebtedness to the company on the contract, including | ||
interest due and accrued, and increased by any existing | ||
additional amounts credited by the company to the contract. In | ||
no event shall any cash surrender benefit be less than the | ||
minimum nonforfeiture amount at that time. The death benefit | ||
under such contracts shall be at least equal to the cash | ||
surrender benefit. | ||
(7) Calculation of Paid-up Annuity Benefits.
For contracts | ||
that do not provide cash surrender benefits, the present value | ||
of any paid-up annuity benefit available as a nonforfeiture | ||
option at any time prior to maturity shall not be less than the | ||
present value of that portion of the maturity value of the | ||
paid-up annuity benefit provided under the contract arising | ||
from considerations paid prior to the time the contract is
| ||
surrendered in exchange for, or changed to, a deferred paid-up | ||
annuity, such present value being calculated for the period | ||
prior to the maturity date on the basis of the interest rate | ||
specified in the contract for accumulating the net | ||
considerations to determine maturity value, and increased by | ||
any additional amounts credited by the company to the | ||
contract. For contracts that do not provide any death benefits | ||
prior to the commencement of any annuity payments, present | ||
values shall be calculated on the basis of such interest rate | ||
and the mortality table specified in the contract for | ||
determining the maturity value of the paid-up annuity benefit. |
However, in no event shall the present value of a paid-up | ||
annuity benefit be less than the minimum nonforfeiture amount | ||
at that time. | ||
(8) Maturity Date.
For the purpose of determining the | ||
benefits calculated under subsections (6) and (7), in the case | ||
of annuity contracts under which an election may be made to | ||
have annuity payments commence at optional maturity dates, the | ||
maturity date shall be deemed to be the latest date for which | ||
election shall be permitted by the contract, but shall not be | ||
deemed to be later than the anniversary of the contract next | ||
following the annuitant's seventieth birthday or the tenth | ||
anniversary of the contract, whichever is later. | ||
(9) Disclosure of Limited Death Benefits.
A contract that | ||
does not provide cash surrender benefits or does not provide | ||
death benefits at least equal to the minimum nonforfeiture | ||
amount prior to the commencement of any annuity payments shall | ||
include a statement in a prominent place in the contract that | ||
such benefits are not
provided. | ||
(10) Inclusion of Lapse of Time Considerations.
Any | ||
paid-up annuity, cash surrender or death benefits available at | ||
any time, other than on the contract anniversary under any | ||
contract with fixed scheduled considerations, shall be | ||
calculated with allowance for the lapse of time and the | ||
payment of any scheduled considerations beyond the beginning | ||
of the contract year in which cessation of payment of | ||
considerations under the contract occurs. |
(11) Proration of Values; Additional Benefits.
For a | ||
contract which provides, within the same contract by rider or | ||
supplemental contract provision, both annuity benefits and | ||
life insurance benefits that are in excess of the greater of | ||
cash surrender benefits or a return of the gross | ||
considerations with interest, the minimum nonforfeiture | ||
benefits shall be equal to the sum of the minimum | ||
nonforfeiture benefits for the annuity portion and the minimum | ||
nonforfeiture benefits, if any, for the life insurance portion | ||
computed as if each portion were a separate contract. | ||
Notwithstanding the provisions of subsections (5), (6), (7), | ||
(8) and (10), additional benefits payable in the event of | ||
total and permanent disability, as reversionary annuity or | ||
deferred reversionary annuity benefits, or as other policy | ||
benefits additional to life insurance, endowment and annuity | ||
benefits, and considerations for all such additional benefits, | ||
shall be disregarded in ascertaining the minimum nonforfeiture | ||
amounts,
paid-up annuity, cash surrender and death benefits | ||
that may be required under this Section. The inclusion of such | ||
benefits shall not be required in any paid-up benefits, unless | ||
the additional benefits separately would require minimum | ||
nonforfeiture amounts, paid-up annuity, cash surrender and | ||
death benefits. | ||
(12) Rules. The Director may adopt rules to implement the | ||
provisions of this Section. | ||
(13) Effective Date. After the effective date of this |
amendatory Act of the 93rd General Assembly, a company may | ||
elect to apply its provisions to annuity
contracts on a | ||
contract form-by-contract form basis before July 1, 2006. In | ||
all other instances, this Section shall become operative with | ||
respect to annuity contracts issued by the company on or after | ||
July 1, 2006.
| ||
(14) (Blank).
| ||
(Source: P.A. 93-873, eff. 8-6-04; 94-1076, eff. 12-29-06 .)
| ||
(215 ILCS 5/353a) (from Ch. 73, par. 965a)
| ||
Sec. 353a.
Accident
and health reserves.
| ||
The reserves for all accident and health policies issued | ||
after the
operative date of this section shall be computed and | ||
maintained on a basis
which shall place an actuarially sound | ||
value on the liabilities under such
policies. To provide a | ||
basis for the determination of such actuarially
sound value, | ||
the Director from time to time shall adopt rules requiring the
| ||
use of appropriate tables of morbidity, mortality, interest | ||
rates and
valuation methods for such reserves for policies | ||
issued before January 1, 2017. For policies issued on or after | ||
January 1, 2017, Section 223 shall govern the basis for | ||
determining such actuarially sound value . In no event shall | ||
such reserves be
less than the pro rata gross unearned premium | ||
reserve for such policies.
| ||
The company shall give the notice required in section 234 | ||
on all
non-cancellable accident and health policies.
|
After this section becomes effective, any company may file | ||
with the
Director written notice of its election to comply | ||
with the provisions of
this section after a specified date | ||
before January 1, 1967. After the
filing of such notice, then | ||
upon such specified date (which shall be the
operative date of | ||
this section for such company), this section shall become
| ||
operative with respect to the accident and health policies | ||
thereafter
issued by such company. If a company makes no such | ||
election, the operative
date of this section for such company | ||
shall be January 1, 1967.
| ||
After this section becomes effective, any company may file | ||
with the
Director written notice of its election to establish | ||
and maintain reserves
upon its accident and health policies | ||
issued prior to the operative date of
this section in | ||
accordance with the standards for reserves established by
this | ||
section, and thereafter the reserve standards prescribed | ||
pursuant to
this section shall be effective with respect to | ||
said accident and health
policies issued prior to the | ||
operative date of this section.
| ||
(Source: Laws 1965, p. 740.)
| ||
(215 ILCS 5/355a) (from Ch. 73, par. 967a)
| ||
Sec. 355a. Standardization of terms and coverage.
| ||
(1) The purposes of this Section shall be (a) to provide
| ||
reasonable standardization and simplification of terms and | ||
coverages of
individual accident and health insurance policies |
to facilitate public
understanding and comparisons; (b) to | ||
eliminate provisions contained in
individual accident and | ||
health insurance policies which may be
misleading or | ||
unreasonably confusing in connection either with the
purchase | ||
of such coverages or with the settlement of claims; and (c) to
| ||
provide for reasonable disclosure in the sale of accident and | ||
health
coverages.
| ||
(2) Definitions applicable to this Section are as follows:
| ||
(a) "Policy" means all or any part of the forms | ||
constituting the
contract between the insurer and the | ||
insured, including the policy,
certificate, subscriber | ||
contract, riders, endorsements, and the
application if | ||
attached, which are subject to filing with and approval
by | ||
the Director.
| ||
(b) "Service corporations" means
voluntary health and | ||
dental
corporations organized and operating respectively | ||
under
the Voluntary Health Services Plans Act and
the | ||
Dental Service Plan Act.
| ||
(c) "Accident and health insurance" means insurance | ||
written under
Article XX of this Code, other than credit | ||
accident and health
insurance, and coverages provided in | ||
subscriber contracts issued by
service corporations. For | ||
purposes of this Section such service
corporations shall | ||
be deemed to be insurers engaged in the business of
| ||
insurance.
| ||
(3) The Director shall issue such rules as he shall deem |
necessary
or desirable to establish specific standards, | ||
including standards of
full and fair disclosure that set forth | ||
the form and content and
required disclosure for sale, of | ||
individual policies of accident and
health insurance, which | ||
rules and regulations shall be in addition to
and in | ||
accordance with the applicable laws of this State, and which | ||
may
cover but shall not be limited to: (a) terms of | ||
renewability; (b)
initial and subsequent conditions of | ||
eligibility; (c) non-duplication of
coverage provisions; (d) | ||
coverage of dependents; (e) pre-existing
conditions; (f) | ||
termination of insurance; (g) probationary periods; (h)
| ||
limitation, exceptions, and reductions; (i) elimination | ||
periods; (j)
requirements regarding replacements; (k) | ||
recurrent conditions; and (l)
the definition of terms, | ||
including, but not limited to, the following:
hospital, | ||
accident, sickness, injury, physician, accidental means, total
| ||
disability, partial disability, nervous disorder, guaranteed | ||
renewable,
and non-cancellable.
| ||
The Director may issue rules that specify prohibited | ||
policy
provisions not otherwise specifically authorized by | ||
statute which in the
opinion of the Director are unjust, | ||
unfair or unfairly discriminatory to
the policyholder, any | ||
person insured under the policy, or beneficiary.
| ||
(4) The Director shall issue such rules as he shall deem | ||
necessary
or desirable to establish minimum standards for | ||
benefits under each
category of coverage in individual |
accident and health policies, other
than conversion policies | ||
issued pursuant to a contractual conversion
privilege under a | ||
group policy, including but not limited to the
following | ||
categories: (a) basic hospital expense coverage; (b) basic
| ||
medical-surgical expense coverage; (c) hospital confinement | ||
indemnity
coverage; (d) major medical expense coverage; (e) | ||
disability income
protection coverage; (f) accident only | ||
coverage; and (g) specified
disease or specified accident | ||
coverage.
| ||
Nothing in this subsection (4) shall preclude the issuance | ||
of any
policy which combines two or more of the categories of | ||
coverage
enumerated in subparagraphs (a) through (f) of this | ||
subsection.
| ||
No policy shall be delivered or issued for delivery in | ||
this State
which does not meet the prescribed minimum | ||
standards for the categories
of coverage listed in this | ||
subsection unless the Director finds that
such policy is | ||
necessary to meet specific needs of individuals or groups
and | ||
such individuals or groups will be adequately informed that | ||
such
policy does not meet the prescribed minimum standards, | ||
and such policy
meets the requirement that the benefits | ||
provided therein are reasonable
in relation to the premium | ||
charged. The standards and criteria to be
used by the Director | ||
in approving such policies shall be included in the
rules | ||
required under this Section with as much specificity as
| ||
practicable.
|
The Director shall prescribe by rule the method of | ||
identification of
policies based upon coverages provided.
| ||
(5) (a) In order to provide for full and fair disclosure in | ||
the
sale of individual accident and health insurance policies, | ||
no such
policy shall be delivered or issued for delivery in | ||
this State unless
the outline of coverage described in | ||
paragraph (b) of this subsection
either accompanies the | ||
policy, or is delivered to the applicant at the
time the | ||
application is made, and an acknowledgment signed by the
| ||
insured, of receipt of delivery of such outline, is provided | ||
to the
insurer. In the event the policy is issued on a basis | ||
other than that
applied for, the outline of coverage properly | ||
describing the policy must
accompany the policy when it is | ||
delivered and such outline shall clearly
state that the policy | ||
differs, and to what extent, from that for which
application | ||
was originally made. All policies, except single premium
| ||
nonrenewal policies, shall have a notice prominently printed | ||
on the
first page of the policy or attached thereto stating in | ||
substance, that
the policyholder shall have the right to | ||
return the policy within 10 days of its delivery and to have | ||
the premium refunded if after
examination of the policy the | ||
policyholder is not satisfied for any
reason.
| ||
(b) The Director shall issue such rules as he shall deem | ||
necessary
or desirable to prescribe the format and content of | ||
the outline of
coverage required by paragraph (a) of this | ||
subsection. "Format" means
style, arrangement, and overall |
appearance, including such items as the
size, color, and | ||
prominence of type and the arrangement of text and
captions. | ||
"Content" shall include without limitation thereto,
statements | ||
relating to the particular policy as to the applicable
| ||
category of coverage prescribed under subsection (4); | ||
principal benefits;
exceptions, reductions and limitations; | ||
and renewal provisions,
including any reservation by the | ||
insurer of a right to change premiums.
Such outline of | ||
coverage shall clearly state that it constitutes a
summary of | ||
the policy issued or applied for and that the policy should
be | ||
consulted to determine governing contractual provisions.
| ||
(c) (Blank). Without limiting the generality of paragraph | ||
(b) of this subsection (5), no qualified health plans shall be | ||
offered for sale directly to consumers through the health | ||
insurance marketplace operating in the State in accordance | ||
with Sections 1311 and
1321 of the federal Patient Protection | ||
and Affordable Care Act of 2010 (Public Law 111-148), as | ||
amended by the federal Health Care and Education | ||
Reconciliation Act of 2010 (Public Law 111-152), and any | ||
amendments thereto, or regulations or guidance issued | ||
thereunder (collectively, "the Federal Act"), unless the | ||
following information is made available to the consumer at the | ||
time he or she is comparing policies and their premiums: | ||
(i) With respect to prescription drug benefits, the | ||
most recently published formulary where a consumer can | ||
view in one location covered prescription drugs; |
information on tiering and the cost-sharing structure for | ||
each tier; and information about how a consumer can obtain | ||
specific copayment amounts or coinsurance percentages for | ||
a specific qualified health plan before enrolling in that | ||
plan. This information shall clearly identify the | ||
qualified health plan to which it applies. | ||
(ii) The most recently published provider directory | ||
where a consumer can view the provider network that | ||
applies to each qualified health plan and information | ||
about each provider, including location, contact | ||
information, specialty, medical group, if any, any | ||
institutional affiliation, and whether the provider is | ||
accepting new patients at each of the specific locations | ||
listing the provider. Dental providers shall notify | ||
qualified health plans electronically or in writing of any | ||
changes to their information as listed in the provider | ||
directory. Qualified health plans shall update their | ||
directories in a manner consistent with the information | ||
provided by the provider or dental management service | ||
organization within 10 business days after being notified | ||
of the change by the provider. Nothing in this paragraph | ||
(ii) shall void any contractual relationship between the | ||
provider and the plan. The information shall clearly | ||
identify the qualified health plan to which it applies. | ||
(d) (Blank). Each company that offers qualified health | ||
plans for sale directly to consumers through the health |
insurance marketplace operating in the State shall make the | ||
information in paragraph (c) of this subsection (5), for each | ||
qualified health plan that it offers, available and accessible | ||
to the general public on the company's Internet website and | ||
through other means for individuals without access to the | ||
Internet. | ||
(e) (Blank). The Department shall ensure that | ||
State-operated Internet websites, in addition to the Internet | ||
website for the health insurance marketplace established in | ||
this State in accordance with the Federal Act, prominently | ||
provide links to Internet-based materials and tools to help | ||
consumers be informed purchasers of health insurance. | ||
(f) (Blank). Nothing in this Section shall be interpreted | ||
or implemented in a manner not consistent with the Federal | ||
Act. This Section shall apply to all qualified health plans | ||
offered for sale directly to consumers through the health | ||
insurance marketplace operating in this State for any coverage | ||
year beginning on or after January 1, 2015. | ||
(6) Prior to the issuance of rules pursuant to this | ||
Section, the
Director shall afford the public, including the | ||
companies affected
thereby, reasonable opportunity for | ||
comment. Such rulemaking is subject
to the provisions of the | ||
Illinois Administrative Procedure Act.
| ||
(7) When a rule has been adopted, pursuant to this | ||
Section, all
policies of insurance or subscriber contracts | ||
which are not in
compliance with such rule shall, when so |
provided in such rule, be
deemed to be disapproved as of a date | ||
specified in such rule not less
than 120 days following its | ||
effective date, without any further or
additional notice other | ||
than the adoption of the rule.
| ||
(8) When a rule adopted pursuant to this Section so | ||
provides, a
policy of insurance or subscriber contract which | ||
does not comply with
the rule shall, not less than 120 days | ||
from the effective date of such
rule, be construed, and the | ||
insurer or service corporation shall be
liable, as if the | ||
policy or contract did comply with the rule.
| ||
(9) Violation of any rule adopted pursuant to this Section | ||
shall be
a violation of the insurance law for purposes of | ||
Sections 370 and 446 of this
Code.
| ||
(Source: P.A. 99-329, eff. 1-1-16; 100-201, eff. 8-18-17.)
| ||
(215 ILCS 5/355c new) | ||
Sec. 355c. Availability of information on qualified health | ||
plans. | ||
(a) Without limiting the generality of paragraph (b) of | ||
subsection (5) of Section 355a, no qualified health plans | ||
shall be offered for sale directly to consumers through the | ||
health insurance marketplace operating in this State in | ||
accordance with Sections 1311 and 1321 of the federal Patient | ||
Protection and Affordable Care Act of 2010 (Public Law | ||
111-148), as amended by the federal Health Care and Education | ||
Reconciliation Act of 2010 (Public Law 111-152), and any |
amendments thereto, or regulations or guidance issued | ||
thereunder (collectively, "the Federal Act"), unless the | ||
following information is made available to the consumer at the | ||
time he or she is comparing policies and their premiums: | ||
(1) With respect to prescription drug benefits, the | ||
most recently published formulary where a consumer can | ||
view in one location covered prescription drugs; | ||
information on tiering and the cost-sharing structure for | ||
each tier; and information about how a consumer can obtain | ||
specific copayment amounts or coinsurance percentages for | ||
a specific qualified health plan before enrolling in that | ||
plan. This information shall clearly identify the | ||
qualified health plan to which it applies. | ||
(2) The most recently published provider directory | ||
where a consumer can view the provider network that | ||
applies to each qualified health plan and information | ||
about each provider, including location, contact | ||
information, specialty, medical group, if any, any | ||
institutional affiliation, and whether the provider is | ||
accepting new patients at each of the specific locations | ||
listing the provider. Dental providers shall notify | ||
qualified health plans electronically or in writing of any | ||
changes to their information as listed in the provider | ||
directory. Qualified health plans shall update their | ||
directories in a manner consistent with the information | ||
provided by the provider or dental management service |
organization within 10 business days after being notified | ||
of the change by the provider. Nothing in this paragraph | ||
(2) shall void any contractual relationship between the | ||
provider and the plan. The information shall clearly | ||
identify the qualified health plan to which it applies. | ||
(b) Each company that offers qualified health plans for | ||
sale directly to consumers through the health insurance | ||
marketplace operating in this State shall make the information | ||
in subsection (a), for each qualified health plan that it | ||
offers, available and accessible to the general public on the | ||
company's website and through other means for individuals | ||
without access to the Internet. | ||
(c) The Department shall ensure that State-operated | ||
websites, in addition to the website for the health insurance | ||
marketplace established in this State in accordance with the | ||
Federal Act, prominently provide links to Internet-based | ||
materials and tools to help consumers be informed purchasers | ||
of health insurance. | ||
(d) Nothing in this Section shall be interpreted or | ||
implemented in a manner not consistent with the Federal Act. | ||
This Section shall apply to all qualified health plans offered | ||
for sale directly to consumers through the health insurance | ||
marketplace operating in this State for any coverage year | ||
beginning on or after January 1, 2015.
| ||
(215 ILCS 5/408) (from Ch. 73, par. 1020)
|
Sec. 408. Fees and charges.
| ||
(1) The Director shall charge, collect and
give proper | ||
acquittances for the payment of the following fees and | ||
charges:
| ||
(a) For filing all documents submitted for the | ||
incorporation or
organization or certification of a | ||
domestic company, except for a fraternal
benefit society, | ||
$2,000.
| ||
(b) For filing all documents submitted for the | ||
incorporation or
organization of a fraternal benefit | ||
society, $500.
| ||
(c) For filing amendments to articles of incorporation | ||
and amendments to
declaration of organization, except for | ||
a fraternal benefit society, a
mutual benefit association, | ||
a burial society or a farm mutual, $200.
| ||
(d) For filing amendments to articles of incorporation | ||
of a fraternal
benefit society, a mutual benefit | ||
association or a burial society, $100.
| ||
(e) For filing amendments to articles of incorporation | ||
of a farm mutual,
$50.
| ||
(f) For filing bylaws or amendments thereto, $50.
| ||
(g) For filing agreement of merger or consolidation:
| ||
(i) for a domestic company, except
for a fraternal | ||
benefit society, a
mutual benefit association, a | ||
burial society,
or a farm mutual, $2,000.
| ||
(ii) for a foreign or
alien company, except for a |
fraternal
benefit society, $600.
| ||
(iii) for a fraternal benefit society,
a mutual | ||
benefit association, a burial society,
or a farm | ||
mutual, $200.
| ||
(h) For filing agreements of reinsurance by a domestic | ||
company, $200.
| ||
(i) For filing all documents submitted by a foreign or | ||
alien
company to be admitted to transact business or | ||
accredited as a
reinsurer in this State, except for a
| ||
fraternal benefit society, $5,000.
| ||
(j) For filing all documents submitted by a foreign or | ||
alien
fraternal benefit society to be admitted to transact | ||
business
in this State, $500.
| ||
(k) For filing declaration of withdrawal of a foreign | ||
or
alien company, $50.
| ||
(l) For filing annual statement by a domestic company, | ||
except a fraternal benefit
society, a mutual benefit | ||
association, a burial society, or
a farm mutual, $200.
| ||
(m) For filing annual statement by a domestic | ||
fraternal benefit
society, $100.
| ||
(n) For filing annual statement by a farm mutual, a | ||
mutual benefit
association, or a burial society, $50.
| ||
(o) For issuing a certificate of authority or
renewal | ||
thereof except to a foreign fraternal benefit society, | ||
$400.
| ||
(p) For issuing a certificate of authority or renewal |
thereof to a foreign
fraternal benefit society, $200.
| ||
(q) For issuing an amended certificate of authority, | ||
$50.
| ||
(r) For each certified copy of certificate of | ||
authority, $20.
| ||
(s) For each certificate of deposit, or valuation, or | ||
compliance
or surety certificate, $20.
| ||
(t) For copies of papers or records per page, $1.
| ||
(u) For each certification to copies
of papers or | ||
records, $10.
| ||
(v) For multiple copies of documents or certificates | ||
listed in
subparagraphs (r), (s), and (u) of paragraph (1) | ||
of this Section, $10 for
the first copy of a certificate of | ||
any type and $5 for each additional copy
of the same | ||
certificate requested at the same time, unless, pursuant | ||
to
paragraph (2) of this Section, the Director finds these | ||
additional fees
excessive.
| ||
(w) For issuing a permit to sell shares or increase | ||
paid-up
capital:
| ||
(i) in connection with a public stock offering, | ||
$300;
| ||
(ii) in any other case, $100.
| ||
(x) For issuing any other certificate required or | ||
permissible
under the law, $50.
| ||
(y) For filing a plan of exchange of the stock of a | ||
domestic
stock insurance company, a plan of |
demutualization of a domestic
mutual company, or a plan of | ||
reorganization under Article XII, $2,000.
| ||
(z) For filing a statement of acquisition of a
| ||
domestic company as defined in Section 131.4 of this Code, | ||
$2,000.
| ||
(aa) For filing an agreement to purchase the business | ||
of an
organization authorized under the Dental Service | ||
Plan Act
or the Voluntary Health Services Plans Act or
of a | ||
health maintenance
organization or a limited health | ||
service organization, $2,000.
| ||
(bb) For filing a statement of acquisition of a | ||
foreign or alien
insurance company as defined in Section | ||
131.12a of this Code, $1,000.
| ||
(cc) For filing a registration statement as required | ||
in Sections 131.13
and 131.14, the notification as | ||
required by Sections 131.16,
131.20a, or 141.4, or an
| ||
agreement or transaction required by Sections 124.2(2), | ||
141, 141a, or
141.1, $200.
| ||
(dd) For filing an application for licensing of:
| ||
(i) a religious or charitable risk pooling trust | ||
or a workers'
compensation pool, $1,000;
| ||
(ii) a workers' compensation service company, | ||
$500;
| ||
(iii) a self-insured automobile fleet, $200; or
| ||
(iv) a renewal of or amendment of any license | ||
issued pursuant to (i),
(ii), or (iii) above, $100.
|
(ee) For filing articles of incorporation for a | ||
syndicate to engage in
the business of insurance through | ||
the Illinois Insurance Exchange, $2,000.
| ||
(ff) For filing amended articles of incorporation for | ||
a syndicate engaged
in the business of insurance through | ||
the Illinois Insurance Exchange, $100.
| ||
(gg) For filing articles of incorporation for a | ||
limited syndicate to
join with other subscribers or | ||
limited syndicates to do business through
the Illinois | ||
Insurance Exchange, $1,000.
| ||
(hh) For filing amended articles of incorporation for | ||
a limited
syndicate to do business through the Illinois | ||
Insurance Exchange, $100.
| ||
(ii) For a permit to solicit subscriptions to a | ||
syndicate
or limited syndicate, $100.
| ||
(jj) For the filing of each form as required in | ||
Section 143 of this
Code, $50 per form. Informational and | ||
advertising filings shall be $25 per filing. The fee for | ||
advisory and rating
organizations shall be $200 per form.
| ||
(i) For the purposes of the form filing fee, | ||
filings made on insert page
basis will be considered | ||
one form at the time of its original submission.
| ||
Changes made to a form subsequent to its approval | ||
shall be considered a
new filing.
| ||
(ii) Only one fee shall be charged for a form, | ||
regardless of the number
of other forms or policies |
with which it will be used.
| ||
(iii) Fees charged for a policy filed as it will be | ||
issued regardless of the number of forms comprising | ||
that policy shall not exceed $1,500. For advisory or | ||
rating organizations, fees charged for a policy filed | ||
as it will be issued regardless of the number of forms | ||
comprising that policy shall not exceed $2,500.
| ||
(iv) The Director may by rule exempt forms from | ||
such fees.
| ||
(kk) For filing an application for licensing of a | ||
reinsurance
intermediary, $500.
| ||
(ll) For filing an application for renewal of a | ||
license of a reinsurance
intermediary, $200.
| ||
(mm) For filing a plan of division of a domestic stock | ||
company under Article IIB, $10,000. | ||
(nn) For filing all documents submitted by a foreign | ||
or alien company to be a certified reinsurer in this | ||
State, except for a fraternal benefit society, $1,000. | ||
(oo) For filing a renewal by a foreign or alien
| ||
company to be a certified reinsurer in this State, except
| ||
for a fraternal benefit society, $400. | ||
(pp) For filing all documents submitted by a reinsurer | ||
domiciled in a reciprocal jurisdiction, $1,000. | ||
(qq) For filing a renewal by a reinsurer domiciled in | ||
a reciprocal jurisdiction, $400. | ||
(rr) For registering a captive management company or |
renewal thereof, $50. | ||
(2) When printed copies or numerous copies of the same | ||
paper or records
are furnished or certified, the Director may | ||
reduce such fees for copies
if he finds them excessive. He may, | ||
when he considers it in the public
interest, furnish without | ||
charge to state insurance departments and persons
other than | ||
companies, copies or certified copies of reports of | ||
examinations
and of other papers and records.
| ||
(3) The expenses incurred in any performance
examination | ||
authorized by law shall be paid by the company or person being
| ||
examined. The charge shall be reasonably related to the cost | ||
of the
examination including but not limited to compensation | ||
of examiners,
electronic data processing costs, supervision | ||
and preparation of an
examination report and lodging and | ||
travel expenses.
All lodging and travel expenses shall be in | ||
accord
with the applicable travel regulations as published by | ||
the Department of
Central Management Services and approved by | ||
the Governor's Travel Control
Board, except that out-of-state | ||
lodging and travel expenses related to
examinations authorized | ||
under Section 132 shall be in accordance with
travel rates | ||
prescribed under paragraph 301-7.2 of the Federal Travel
| ||
Regulations, 41 C.F.R. 301-7.2, for reimbursement of | ||
subsistence expenses
incurred during official travel. All | ||
lodging and travel expenses may be reimbursed directly upon | ||
authorization of the
Director. With the exception of the
| ||
direct reimbursements authorized by the
Director, all |
performance examination charges collected by the
Department | ||
shall be paid
to the Insurance Producer Administration Fund,
| ||
however, the electronic data processing costs
incurred by the | ||
Department in the performance of any examination shall be
| ||
billed directly to the company being examined for payment to | ||
the Technology Management
Revolving Fund.
| ||
(4) At the time of any service of process on the Director
| ||
as attorney for such service, the Director shall charge and | ||
collect the
sum of $40 $20 , which may be recovered as taxable | ||
costs by
the party to the suit or action causing such service | ||
to be made if he prevails
in such suit or action.
| ||
(5) (a) The costs incurred by the Department of Insurance
| ||
in conducting any hearing authorized by law shall be assessed | ||
against the
parties to the hearing in such proportion as the | ||
Director of Insurance may
determine upon consideration of all | ||
relevant circumstances including: (1)
the nature of the | ||
hearing; (2) whether the hearing was instigated by, or
for the | ||
benefit of a particular party or parties; (3) whether there is | ||
a
successful party on the merits of the proceeding; and (4) the | ||
relative levels
of participation by the parties.
| ||
(b) For purposes of this subsection (5) costs incurred | ||
shall
mean the hearing officer fees, court reporter fees, and | ||
travel expenses
of Department of Insurance officers and | ||
employees; provided however, that
costs incurred shall not | ||
include hearing officer fees or court reporter
fees unless the | ||
Department has retained the services of independent
|
contractors or outside experts to perform such functions.
| ||
(c) The Director shall make the assessment of costs | ||
incurred as part of
the final order or decision arising out of | ||
the proceeding; provided, however,
that such order or decision | ||
shall include findings and conclusions in support
of the | ||
assessment of costs. This subsection (5) shall not be | ||
construed as
permitting the payment of travel expenses unless | ||
calculated in accordance
with the applicable travel | ||
regulations of the Department
of Central Management Services, | ||
as approved by the Governor's Travel Control
Board. The | ||
Director as part of such order or decision shall require all
| ||
assessments for hearing officer fees and court reporter fees, | ||
if any, to
be paid directly to the hearing officer or court | ||
reporter by the party(s)
assessed for such costs. The | ||
assessments for travel expenses of Department
officers and | ||
employees shall be reimbursable to the
Director of Insurance | ||
for
deposit to the fund out of which those expenses had been | ||
paid.
| ||
(d) The provisions of this subsection (5) shall apply in | ||
the case of any
hearing conducted by the Director of Insurance | ||
not otherwise specifically
provided for by law.
| ||
(6) The Director shall charge and collect an annual | ||
financial
regulation fee from every domestic company for | ||
examination and analysis of
its financial condition and to | ||
fund the internal costs and expenses of the
Interstate | ||
Insurance Receivership Commission as may be allocated to the |
State
of Illinois and companies doing an insurance business in | ||
this State pursuant to
Article X of the Interstate Insurance | ||
Receivership Compact. The fee shall be
the greater fixed | ||
amount based upon
the combination of nationwide direct premium | ||
income and
nationwide reinsurance
assumed premium
income or | ||
upon admitted assets calculated under this subsection as | ||
follows:
| ||
(a) Combination of nationwide direct premium income | ||
and
nationwide reinsurance assumed premium.
| ||
(i) $150, if the premium is less than $500,000 and | ||
there is
no
reinsurance assumed premium;
| ||
(ii) $750, if the premium is $500,000 or more, but | ||
less
than $5,000,000
and there is no reinsurance | ||
assumed premium; or if the premium is less than
| ||
$5,000,000 and the reinsurance assumed premium is less | ||
than $10,000,000;
| ||
(iii) $3,750, if the premium is less than | ||
$5,000,000 and
the reinsurance
assumed premium is | ||
$10,000,000 or more;
| ||
(iv) $7,500, if the premium is $5,000,000 or more, | ||
but
less than
$10,000,000;
| ||
(v) $18,000, if the premium is $10,000,000 or | ||
more, but
less than $25,000,000;
| ||
(vi) $22,500, if the premium is $25,000,000 or | ||
more, but
less
than $50,000,000;
| ||
(vii) $30,000, if the premium is $50,000,000 or |
more,
but less than $100,000,000;
| ||
(viii) $37,500, if the premium is $100,000,000 or | ||
more.
| ||
(b) Admitted assets.
| ||
(i) $150, if admitted assets are less than | ||
$1,000,000;
| ||
(ii) $750, if admitted assets are $1,000,000 or | ||
more, but
less than
$5,000,000;
| ||
(iii) $3,750, if admitted assets are $5,000,000 or | ||
more,
but less than
$25,000,000;
| ||
(iv) $7,500, if admitted assets are $25,000,000 or | ||
more,
but less than
$50,000,000;
| ||
(v) $18,000, if admitted assets are $50,000,000 or | ||
more,
but less than
$100,000,000;
| ||
(vi) $22,500, if admitted assets are $100,000,000 | ||
or
more, but less
than $500,000,000;
| ||
(vii) $30,000, if admitted assets are $500,000,000 | ||
or
more, but less
than $1,000,000,000;
| ||
(viii) $37,500, if admitted assets are | ||
$1,000,000,000
or more.
| ||
(c) The sum of financial regulation fees charged to | ||
the domestic
companies of the same affiliated group shall | ||
not exceed $250,000
in the aggregate in any single year | ||
and shall be billed by the Director to
the member company | ||
designated by the
group.
| ||
(7) The Director shall charge and collect an annual |
financial regulation
fee from every foreign or alien company, | ||
except fraternal benefit
societies, for the
examination and | ||
analysis of its financial condition and to fund the internal
| ||
costs and expenses of the Interstate Insurance Receivership | ||
Commission as may
be allocated to the State of Illinois and | ||
companies doing an insurance business
in this State pursuant | ||
to Article X of the Interstate Insurance Receivership
Compact.
| ||
The fee shall be a fixed amount based upon Illinois direct | ||
premium income
and nationwide reinsurance assumed premium | ||
income in accordance with the
following schedule:
| ||
(a) $150, if the premium is less than $500,000 and | ||
there is
no
reinsurance assumed premium;
| ||
(b) $750, if the premium is $500,000 or more, but less | ||
than
$5,000,000
and there is no reinsurance assumed | ||
premium;
or if the premium is less than $5,000,000 and the | ||
reinsurance assumed
premium is less than $10,000,000;
| ||
(c) $3,750, if the premium is less than $5,000,000 and | ||
the
reinsurance
assumed premium is $10,000,000 or more;
| ||
(d) $7,500, if the premium is $5,000,000 or more, but | ||
less
than
$10,000,000;
| ||
(e) $18,000, if the premium is $10,000,000 or more, | ||
but
less than
$25,000,000;
| ||
(f) $22,500, if the premium is $25,000,000 or more, | ||
but
less than
$50,000,000;
| ||
(g) $30,000, if the premium is $50,000,000 or more, | ||
but
less than
$100,000,000;
|
(h) $37,500, if the premium is $100,000,000 or more.
| ||
The sum of financial regulation fees under this subsection | ||
(7)
charged to the foreign or alien companies within the same | ||
affiliated group
shall not exceed $250,000 in the aggregate in | ||
any single year
and shall be
billed by the Director to the | ||
member company designated by the group.
| ||
(8) Beginning January 1, 1992, the financial regulation | ||
fees imposed
under subsections (6) and (7)
of this Section | ||
shall be paid by each company or domestic affiliated group
| ||
annually. After January
1, 1994, the fee shall be billed by | ||
Department invoice
based upon the company's
premium income or | ||
admitted assets as shown in its annual statement for the
| ||
preceding calendar year. The invoice is due upon
receipt and | ||
must be paid no later than June 30 of each calendar year. All
| ||
financial
regulation fees collected by the Department shall be | ||
paid to the Insurance
Financial Regulation Fund. The | ||
Department may not collect financial
examiner per diem charges | ||
from companies subject to subsections (6) and (7)
of this | ||
Section undergoing financial examination
after June 30, 1992.
| ||
(9) In addition to the financial regulation fee required | ||
by this
Section, a company undergoing any financial | ||
examination authorized by law
shall pay the following costs | ||
and expenses incurred by the Department:
electronic data | ||
processing costs, the expenses authorized under Section 131.21
| ||
and
subsection (d) of Section 132.4 of this Code, and lodging | ||
and travel expenses.
|
Electronic data processing costs incurred by the | ||
Department in the
performance of any examination shall be | ||
billed directly to the company
undergoing examination for | ||
payment to the Technology Management Revolving
Fund. Except | ||
for direct reimbursements authorized by the Director or
direct | ||
payments made under Section 131.21 or subsection (d) of | ||
Section
132.4 of this Code, all financial regulation fees and | ||
all financial
examination charges collected by the Department | ||
shall be paid to the
Insurance Financial Regulation Fund.
| ||
All lodging and travel expenses shall be in accordance | ||
with applicable
travel regulations published by the Department | ||
of Central Management
Services and approved by the Governor's | ||
Travel Control Board, except that
out-of-state lodging and | ||
travel expenses related to examinations authorized
under | ||
Sections 132.1 through 132.7 shall be in accordance
with | ||
travel rates prescribed
under paragraph 301-7.2 of the Federal | ||
Travel Regulations, 41 C.F.R. 301-7.2,
for reimbursement of | ||
subsistence expenses incurred during official travel.
All | ||
lodging and travel expenses may be
reimbursed directly upon | ||
the authorization of the Director.
| ||
In the case of an organization or person not subject to the | ||
financial
regulation fee, the expenses incurred in any | ||
financial examination authorized
by law shall be paid by the | ||
organization or person being examined. The charge
shall be | ||
reasonably related to the cost of the examination including, | ||
but not
limited to, compensation of examiners and other costs |
described in this
subsection.
| ||
(10) Any company, person, or entity failing to make any | ||
payment of $150
or more as required under this Section shall be | ||
subject to the penalty and
interest provisions provided for in | ||
subsections (4) and (7)
of Section 412.
| ||
(11) Unless otherwise specified, all of the fees collected | ||
under this
Section shall be paid into the Insurance Financial | ||
Regulation Fund.
| ||
(12) For purposes of this Section:
| ||
(a) "Domestic company" means a company as defined in | ||
Section 2 of this
Code which is incorporated or organized | ||
under the laws of this State, and in
addition includes a | ||
not-for-profit corporation authorized under the Dental
| ||
Service Plan Act or the Voluntary Health
Services Plans | ||
Act, a health maintenance organization, and a
limited
| ||
health service organization.
| ||
(b) "Foreign company" means a company as defined in | ||
Section 2 of this
Code which is incorporated or organized | ||
under the laws of any state of the
United States other than | ||
this State and in addition includes a health
maintenance | ||
organization and a limited health service organization | ||
which is
incorporated or organized under the laws
of any | ||
state of the United States other than this State.
| ||
(c) "Alien company" means a company as defined in | ||
Section 2 of this Code
which is incorporated or organized | ||
under the laws of any country other than
the United |
States.
| ||
(d) "Fraternal benefit society" means a corporation, | ||
society, order,
lodge or voluntary association as defined | ||
in Section 282.1 of this
Code.
| ||
(e) "Mutual benefit association" means a company, | ||
association or
corporation authorized by the Director to | ||
do business in this State under
the provisions of Article | ||
XVIII of this Code.
| ||
(f) "Burial society" means a person, firm, | ||
corporation, society or
association of individuals | ||
authorized by the Director to do business in
this State | ||
under the provisions of Article XIX of this Code.
| ||
(g) "Farm mutual" means a district, county and | ||
township mutual insurance
company authorized by the | ||
Director to do business in this State under the
provisions | ||
of the Farm Mutual Insurance Company Act of 1986.
| ||
(Source: P.A. 100-23, eff. 7-6-17.)
| ||
(215 ILCS 5/412) (from Ch. 73, par. 1024)
| ||
Sec. 412. Refunds; penalties; collection.
| ||
(1)(a) Whenever it appears to
the satisfaction of the | ||
Director that because of some mistake of fact,
error in | ||
calculation, or erroneous interpretation of a statute of this
| ||
or any other state, any authorized company, surplus line | ||
producer, or industrial insured has paid to him, pursuant to
| ||
any provision of law, taxes, fees, or other charges
in excess |
of the
amount legally chargeable against it, during the 6 year | ||
period
immediately preceding the discovery of such | ||
overpayment, he shall have
power to refund to such company, | ||
surplus line producer, or industrial insured the amount of the | ||
excess or excesses by
applying the amount or amounts thereof | ||
toward
the payment of taxes, fees, or other charges already | ||
due, or which may
thereafter become due from that company | ||
until such excess or excesses have been
fully
refunded, or | ||
upon a written request from the authorized company, surplus | ||
line producer, or industrial insured, the
Director shall | ||
provide a cash refund within
120 days after receipt of the | ||
written request if all necessary information has
been filed | ||
with the Department in order for it to perform an audit of the
| ||
tax report for the transaction or period or annual return for | ||
the year in which the overpayment occurred or within 120 days
| ||
after the date the Department receives all the necessary | ||
information to perform
such audit. The Director shall not | ||
provide a cash refund if there are
insufficient funds in the | ||
Insurance Premium Tax Refund Fund to provide a cash
refund, if | ||
the amount of the overpayment is less than $100, or if the | ||
amount of
the overpayment can be fully offset against the | ||
taxpayer's estimated liability
for the year following the year | ||
of the cash refund request. Any cash refund
shall be paid from | ||
the Insurance Premium Tax Refund Fund, a special fund hereby
| ||
created in the
State treasury.
| ||
(b) As determined by the Director pursuant to paragraph |
(a) of this subsection Beginning January 1, 2000 and | ||
thereafter , the Department shall deposit an amount of cash | ||
refunds approved by the Director for payment as a result of | ||
overpayment of tax liability
a percentage of the amounts | ||
collected under Sections 121-2.08, 409, 444, and 444.1 , and | ||
445 of
this
Code into the Insurance Premium Tax Refund Fund. | ||
The percentage deposited into
the Insurance Premium Tax Refund | ||
Fund shall be the annual percentage. The
annual
percentage | ||
shall be calculated as a fraction, the numerator of which | ||
shall be
the amount of cash refunds approved by the Director | ||
for payment and paid during
the preceding calendar year as a | ||
result of overpayment of tax liability under
Sections | ||
121-2.08, 409, 444, 444.1, and 445 of this Code and the | ||
denominator of which shall
be the amounts collected pursuant | ||
to Sections 121-2.08, 409, 444, 444.1, and 445 of this Code
| ||
during the preceding calendar year. However, if there were no | ||
cash refunds
paid in a preceding calendar year, the Department | ||
shall deposit 5% of the
amount collected in that preceding | ||
calendar year pursuant to Sections 121-2.08, 409, 444,
444.1, | ||
and 445 of this Code into the Insurance Premium Tax Refund Fund | ||
instead of an
amount calculated by using the annual | ||
percentage.
| ||
(c) Beginning July 1, 1999, moneys in the Insurance | ||
Premium Tax Refund
Fund
shall be expended exclusively for the | ||
purpose of paying cash refunds resulting
from overpayment of | ||
tax liability under Sections 121-2.08, 409, 444, 444.1, and |
445 of this
Code
as
determined by the Director pursuant to | ||
subsection 1(a) of this Section. Cash
refunds made in | ||
accordance with this Section may be made from the Insurance
| ||
Premium Tax Refund Fund only to the extent that amounts have | ||
been deposited and
retained in the Insurance Premium Tax | ||
Refund Fund.
| ||
(d) This Section shall constitute an irrevocable and | ||
continuing
appropriation from the Insurance Premium Tax Refund | ||
Fund for the purpose of
paying cash refunds pursuant to the | ||
provisions of this Section.
| ||
(2)(a) When any insurance company fails to
file any tax | ||
return required under Sections 408.1, 409, 444, and 444.1 of
| ||
this Code or Section 12 of the Fire Investigation Act on the | ||
date
prescribed, including any extensions, there shall be | ||
added as a penalty
$400 or 10% of the amount of such tax, | ||
whichever is
greater, for each month
or part of a month of | ||
failure to file, the entire penalty not to exceed
$2,000 or 50% | ||
of the tax due, whichever is greater.
| ||
(b) When any industrial insured or surplus line producer | ||
fails to file any tax return or report required under Sections | ||
121-2.08 and 445 of this Code or Section 12 of the Fire | ||
Investigation Act on the date prescribed, including any | ||
extensions, there shall be added: | ||
(i) as a late fee, if the return or report is received | ||
at least one day but not more than 7 days after the | ||
prescribed due date, $400 or 10% of the tax due, whichever |
is greater, the entire fee not to exceed $1,000; | ||
(ii) as a late fee, if the return or report is received | ||
at least 8 days but not more than 14 days after the | ||
prescribed due date, $400 or 10% of the tax due, whichever | ||
is greater, the entire fee not to exceed $1,500; | ||
(iii) as a late fee, if the return or report is | ||
received at least 15 days but not more than 21 days after | ||
the prescribed due date, $400 or 10% of the tax due, | ||
whichever is greater, the entire fee not to exceed $2,000; | ||
or | ||
(iv) as a penalty, if the return or report is received | ||
more than 21 days after the prescribed due date, $400 or | ||
10% of the tax due, whichever is greater, for each month or | ||
part of a month of failure to file, the entire penalty not | ||
to exceed $2,000 or 50% of the tax due, whichever is | ||
greater. | ||
A tax return or report shall be deemed received as of the | ||
date mailed as evidenced by a postmark, proof of mailing on a | ||
recognized United States Postal Service form or a form | ||
acceptable to the United States Postal Service or other | ||
commercial mail delivery service, or other evidence acceptable | ||
to the Director.
| ||
(3)(a) When any insurance company
fails to pay the full | ||
amount due under the provisions of this Section,
Sections | ||
408.1, 409, 444, or 444.1 of this Code, or Section 12 of the
| ||
Fire Investigation Act, there shall be added to the amount due |
as a penalty
an amount equal to 10% of the deficiency.
| ||
(a-5) When any industrial insured or surplus line producer | ||
fails to pay the full amount due under the provisions of this | ||
Section, Sections 121-2.08 or 445 of this Code, or Section 12 | ||
of the Fire Investigation Act on the date prescribed, there | ||
shall be added: | ||
(i) as a late fee, if the payment is received at least | ||
one day but not more than 7 days after the prescribed due | ||
date, 10% of the tax due, the entire fee not to exceed | ||
$1,000; | ||
(ii) as a late fee, if the payment is received at least | ||
8 days but not more than 14 days after the prescribed due | ||
date, 10% of the tax due, the entire fee not to exceed | ||
$1,500; | ||
(iii) as a late fee, if the payment is received at | ||
least 15 days but not more than 21 days after the | ||
prescribed due date, 10% of the tax due, the entire fee not | ||
to exceed $2,000; or | ||
(iv) as a penalty, if the return or report is received | ||
more than 21 days after the prescribed due date, 10% of the | ||
tax due. | ||
A tax payment shall be deemed received as of the date | ||
mailed as evidenced by a postmark, proof of mailing on a | ||
recognized United States Postal Service form or a form | ||
acceptable to the United States Postal Service or other | ||
commercial mail delivery service, or other evidence acceptable |
to the Director.
| ||
(b) If such failure to pay is determined by the Director to | ||
be wilful,
after a hearing under Sections 402 and 403, there | ||
shall be added to the tax
as a penalty an amount equal to the | ||
greater of 50% of the
deficiency or 10%
of the amount due and | ||
unpaid for each month or part of a month that the
deficiency | ||
remains unpaid commencing with the date that the amount | ||
becomes
due. Such amount shall be in lieu of any determined | ||
under paragraph (a) or (a-5).
| ||
(4) Any insurance company, industrial insured, or surplus | ||
line producer that
fails to pay the full amount due under this | ||
Section or Sections 121-2.08, 408.1, 409,
444, 444.1, or 445 | ||
of this Code, or Section 12 of the Fire Investigation
Act is | ||
liable, in addition to the tax and any late fees and penalties, | ||
for interest
on such deficiency at the rate of 12% per annum, | ||
or at such higher adjusted
rates as are or may be established | ||
under subsection (b) of Section 6621
of the Internal Revenue | ||
Code, from the date that payment of any such tax
was due, | ||
determined without regard to any extensions, to the date of | ||
payment
of such amount.
| ||
(5) The Director, through the Attorney
General, may | ||
institute an action in the name of the People of the State
of | ||
Illinois, in any court of competent jurisdiction, for the | ||
recovery of
the amount of such taxes, fees, and penalties due, | ||
and prosecute the same to
final judgment, and take such steps | ||
as are necessary to collect the same.
|
(6) In the event that the certificate of authority of a | ||
foreign or
alien company is revoked for any cause or the | ||
company withdraws from
this State prior to the renewal date of | ||
the certificate of authority as
provided in Section 114, the | ||
company may recover the amount of any such
tax paid in advance. | ||
Except as provided in this subsection, no
revocation or | ||
withdrawal excuses payment of or constitutes grounds for
the | ||
recovery of any taxes or penalties imposed by this Code.
| ||
(7) When an insurance company or domestic affiliated group | ||
fails to pay
the full amount of any fee of $200 or more due | ||
under
Section 408 of this Code, there shall be added to the | ||
amount due as
a penalty the greater of $100 or an amount equal | ||
to 10%
of the deficiency for
each month or part of
a month that | ||
the deficiency remains unpaid.
| ||
(8) The Department shall have a lien for the taxes, fees, | ||
charges, fines, penalties, interest, other charges, or any | ||
portion thereof, imposed or assessed pursuant to this Code, | ||
upon all the real and personal property of any company or | ||
person to whom the assessment or final order has been issued or | ||
whenever a tax return is filed without payment of the tax or | ||
penalty shown therein to be due, including all such property | ||
of the company or person acquired after receipt of the | ||
assessment, issuance of the order, or filing of the return. | ||
The company or person is liable for the filing fee incurred by | ||
the Department for filing the lien and the filing fee incurred | ||
by the Department to file the release of that lien. The filing |
fees shall be paid to the Department in addition to payment of | ||
the tax, fee, charge, fine, penalty, interest, other charges, | ||
or any portion thereof, included in the amount of the lien. | ||
However, where the lien arises because of the issuance of a | ||
final order of the Director or tax assessment by the | ||
Department, the lien shall not attach and the notice referred | ||
to in this Section shall not be filed until all administrative | ||
proceedings or proceedings in court for review of the final | ||
order or assessment have terminated or the time for the taking | ||
thereof has expired without such proceedings being instituted. | ||
Upon the granting of Department review after a lien has | ||
attached, the lien shall remain in full force except to the | ||
extent to which the final assessment may be reduced by a | ||
revised final assessment following the rehearing or review. | ||
The lien created by the issuance of a final assessment shall | ||
terminate, unless a notice of lien is filed, within 3 years | ||
after the date all proceedings in court for the review of the | ||
final assessment have terminated or the time for the taking | ||
thereof has expired without such proceedings being instituted, | ||
or (in the case of a revised final assessment issued pursuant | ||
to a rehearing or review by the Department) within 3 years | ||
after the date all proceedings in court for the review of such | ||
revised final assessment have terminated or the time for the | ||
taking thereof has expired without such proceedings being | ||
instituted. Where the lien results from the filing of a tax | ||
return without payment of the tax or penalty shown therein to |
be due, the lien shall terminate, unless a notice of lien is | ||
filed, within 3 years after the date when the return is filed | ||
with the Department. | ||
The time limitation period on the Department's right to | ||
file a notice of lien shall not run during any period of time | ||
in which the order of any court has the effect of enjoining or | ||
restraining the Department from filing such notice of lien. If | ||
the Department finds that a company or person is about to | ||
depart from the State, to conceal himself or his property, or | ||
to do any other act tending to prejudice or to render wholly or | ||
partly ineffectual proceedings to collect the amount due and | ||
owing to the Department unless such proceedings are brought | ||
without delay, or if the Department finds that the collection | ||
of the amount due from any company or person will be | ||
jeopardized by delay, the Department shall give the company or | ||
person notice of such findings and shall make demand for | ||
immediate return and payment of the amount, whereupon the | ||
amount shall become immediately due and payable. If the | ||
company or person, within 5 days after the notice (or within | ||
such extension of time as the Department may grant), does not | ||
comply with the notice or show to the Department that the | ||
findings in the notice are erroneous, the Department may file | ||
a notice of jeopardy assessment lien in the office of the | ||
recorder of the county in which any property of the company or | ||
person may be located and shall notify the company or person of | ||
the filing. The jeopardy assessment lien shall have the same |
scope and effect as the statutory lien provided for in this | ||
Section. If the company or person believes that the company or | ||
person does not owe some or all of the tax for which the | ||
jeopardy assessment lien against the company or person has | ||
been filed, or that no jeopardy to the revenue in fact exists, | ||
the company or person may protest within 20 days after being | ||
notified by the Department of the filing of the jeopardy | ||
assessment lien and request a hearing, whereupon the | ||
Department shall hold a hearing in conformity with the | ||
provisions of this Code and, pursuant thereto, shall notify | ||
the company or person of its findings as to whether or not the | ||
jeopardy assessment lien will be released. If not, and if the | ||
company or person is aggrieved by this decision, the company | ||
or person may file an action for judicial review of the final | ||
determination of the Department in accordance with the | ||
Administrative Review Law. If, pursuant to such hearing (or | ||
after an independent determination of the facts by the | ||
Department without a hearing), the Department determines that | ||
some or all of the amount due covered by the jeopardy | ||
assessment lien is not owed by the company or person, or that | ||
no jeopardy to the revenue exists, or if on judicial review the | ||
final judgment of the court is that the company or person does | ||
not owe some or all of the amount due covered by the jeopardy | ||
assessment lien against them, or that no jeopardy to the | ||
revenue exists, the Department shall release its jeopardy | ||
assessment lien to the extent of such finding of nonliability |
for the amount, or to the extent of such finding of no jeopardy | ||
to the revenue. The Department shall also release its jeopardy | ||
assessment lien against the company or person whenever the | ||
amount due and owing covered by the lien, plus any interest | ||
which may be due, are paid and the company or person has paid | ||
the Department in cash or by guaranteed remittance an amount | ||
representing the filing fee for the lien and the filing fee for | ||
the release of that lien. The Department shall file that | ||
release of lien with the recorder of the county where that lien | ||
was filed. | ||
Nothing in this Section shall be construed to give the | ||
Department a preference over the rights of any bona fide | ||
purchaser, holder of a security interest, mechanics | ||
lienholder, mortgagee, or judgment lien creditor arising prior | ||
to the filing of a regular notice of lien or a notice of | ||
jeopardy assessment lien in the office of the recorder in the | ||
county in which the property subject to the lien is located. | ||
For purposes of this Section, "bona fide" shall not include | ||
any mortgage of real or personal property or any other credit | ||
transaction that results in the mortgagee or the holder of the | ||
security acting as trustee for unsecured creditors of the | ||
company or person mentioned in the notice of lien who executed | ||
such chattel or real property mortgage or the document | ||
evidencing such credit transaction. The lien shall be inferior | ||
to the lien of general taxes, special assessments, and special | ||
taxes levied by any political subdivision of this State. In |
case title to land to be affected by the notice of lien or | ||
notice of jeopardy assessment lien is registered under the | ||
provisions of the Registered Titles (Torrens) Act, such notice | ||
shall be filed in the office of the Registrar of Titles of the | ||
county within which the property subject to the lien is | ||
situated and shall be entered upon the register of titles as a | ||
memorial or charge upon each folium of the register of titles | ||
affected by such notice, and the Department shall not have a | ||
preference over the rights of any bona fide purchaser, | ||
mortgagee, judgment creditor, or other lienholder arising | ||
prior to the registration of such notice. The regular lien or | ||
jeopardy assessment lien shall not be effective against any | ||
purchaser with respect to any item in a retailer's stock in | ||
trade purchased from the retailer in the usual course of the | ||
retailer's business. | ||
(Source: P.A. 98-158, eff. 8-2-13; 98-978, eff. 1-1-15 .)
| ||
(215 ILCS 5/416)
| ||
Sec. 416. Illinois Workers' Compensation
Commission | ||
Operations Fund Surcharge.
| ||
(a) As of July 30, 2004 (the effective date of Public Act | ||
93-840), every company licensed or
authorized by the Illinois | ||
Department of Insurance and insuring employers'
liabilities | ||
arising under the Workers' Compensation Act or the Workers'
| ||
Occupational Diseases Act shall remit to the Director a | ||
surcharge based upon
the annual direct written premium, as |
reported under Section 136 of this Act,
of the company in the | ||
manner provided in this
Section. Such
proceeds shall
be | ||
deposited into the Illinois Workers' Compensation
Commission | ||
Operations Fund as
established in
the Workers' Compensation | ||
Act. If a company
survives or
was formed by a merger, | ||
consolidation, reorganization, or reincorporation, the
direct
| ||
written premiums of all companies party to the merger, | ||
consolidation,
reorganization, or
reincorporation shall, for | ||
purposes of determining the amount of the fee
imposed by this
| ||
Section, be regarded as those of the surviving or new company.
| ||
(b)(1) Except as provided in subsection (b)(2) of this | ||
Section, beginning on
July 30, 2004 (the effective date of | ||
Public Act 93-840) and on July 1 of each year thereafter,
the
| ||
Director shall
charge an annual Illinois Workers' Compensation | ||
Commission Operations Fund Surcharge from every
company | ||
subject to subsection (a) of this Section equal to 1.01% of its | ||
direct
written
premium for insuring employers' liabilities | ||
arising under the Workers'
Compensation Act or Workers' | ||
Occupational Diseases Act as reported in each
company's
annual
| ||
statement filed for the previous year as required by Section | ||
136. The
Illinois Workers' Compensation Commission Operations | ||
Fund Surcharge shall be collected by companies
subject to | ||
subsection (a) of this Section as a separately stated | ||
surcharge on
insured employers at the rate of 1.01% of direct | ||
written premium. The
Illinois Workers' Compensation Commission | ||
Operations Fund Surcharge shall not be collected by companies
|
subject to subsection (a) of this Section from any employer | ||
that self-insures its liabilities arising under the Workers' | ||
Compensation Act or Workers' Occupational Diseases Act, | ||
provided that the employer has paid the Illinois Workers' | ||
Compensation Commission Operations Fund Fee pursuant to | ||
Section 4d of the Workers' Compensation Act. All sums
| ||
collected by
the Department of Insurance under the provisions | ||
of this Section shall be paid
promptly
after the receipt of the | ||
same, accompanied by a detailed statement thereof,
into the
| ||
Illinois Workers' Compensation Commission Operations Fund in | ||
the State treasury.
| ||
(b)(2) The surcharge due pursuant to Public Act 93-840 | ||
shall be collected instead of the surcharge due on July 1, 2004 | ||
under Public Act 93-32. Payment of the surcharge due under | ||
Public Act 93-840 shall discharge the employer's obligations | ||
due on July 1, 2004.
| ||
(c) In addition to the authority specifically granted | ||
under Article XXV of
this
Code, the Director shall have such | ||
authority to adopt rules or establish forms
as may be
| ||
reasonably necessary for purposes of enforcing this Section. | ||
The Director shall
also have
authority to defer, waive, or | ||
abate the surcharge or any penalties imposed by
this
Section | ||
if in
the Director's opinion the company's solvency and | ||
ability to meet its insured
obligations
would be immediately | ||
threatened by payment of the surcharge due.
| ||
(d) When a company fails to pay the full amount of any |
annual
Illinois Workers' Compensation
Commission Operations | ||
Fund Surcharge of $100 or more due under this Section,
there
| ||
shall be
added to the amount due as a penalty the greater of | ||
$1,000 or an amount equal
to 10% 5% of
the deficiency for each | ||
month or part of a month that the deficiency remains
unpaid.
| ||
(e) The Department of Insurance may enforce the collection | ||
of any delinquent
payment, penalty, or portion thereof by | ||
legal action or in any other manner by
which the
collection of | ||
debts due the State of Illinois may be enforced under the laws | ||
of
this State.
| ||
(f) Whenever it appears to the satisfaction of the | ||
Director that a company
has
paid
pursuant to this Act an | ||
Illinois Workers' Compensation Commission Operations Fund | ||
Surcharge in
an amount
in excess of the amount legally | ||
collectable from the company, the Director
shall issue a
| ||
credit memorandum for an amount equal to the amount of such | ||
overpayment. A
credit
memorandum may be applied for the 2-year | ||
period from the date of issuance,
against the
payment of any | ||
amount due during that period under the surcharge imposed by
| ||
this
Section or,
subject to reasonable rule of the Department | ||
of Insurance including requirement
of
notification, may be | ||
assigned to any other company subject to regulation under
this | ||
Act.
Any application of credit memoranda after the period | ||
provided for in this
Section is void.
| ||
(g) Annually, the Governor may direct a transfer of up to | ||
2% of all moneys
collected under this Section to the Insurance |
Financial Regulation Fund.
| ||
(Source: P.A. 95-331, eff. 8-21-07.)
| ||
(215 ILCS 5/356z.27 rep.) | ||
Section 15. The Illinois Insurance Code is amended by | ||
repealing Section 356z.27. | ||
Section 20. The Illinois Health Insurance Portability and | ||
Accountability Act is amended by changing Section 20 as | ||
follows:
| ||
(215 ILCS 97/20)
| ||
Sec. 20.
Increased portability through prohibition of | ||
limitation on preexisting
condition exclusions.
| ||
(A) No health insurance coverage issued, amended, | ||
delivered, or renewed on or after the effective date of this | ||
amendatory Act of the 102nd General Assembly may impose any | ||
preexisting condition exclusion with respect to the plan or | ||
coverage. This provision does not apply to the provision of | ||
excepted benefits as described in paragraph (2) of subsection | ||
(C). Limitation of preexisting condition exclusion period;
| ||
crediting for periods of previous coverage. Subject
to | ||
subsection (D), a group health plan, and a health
insurance | ||
issuer offering group health insurance
coverage, may, with | ||
respect to a participant or
beneficiary, impose a preexisting | ||
condition exclusion
only if:
|
(1) the exclusion relates to a condition (whether
| ||
physical or mental), regardless of the cause of
the | ||
condition, for which medical advice,
diagnosis, care, or | ||
treatment was recommended or
received
within the 6-month | ||
period ending on the enrollment
date;
| ||
(2) the exclusion extends for a period of not more
| ||
than 12 months (or 18 months in the case of a late
| ||
enrollee) after the enrollment date; and
| ||
(3) the period of any such preexisting condition
| ||
exclusion is reduced by the aggregate of the periods
of | ||
creditable coverage (if any, as defined in
subsection | ||
(C)(1)) applicable to the participant or
beneficiary as of | ||
the enrollment date.
| ||
(B) (Blank). Preexisting condition exclusion. A group
| ||
health plan, and health insurance issuer offering
group health | ||
insurance coverage, may not impose
any preexisting condition | ||
exclusion relating to
pregnancy as a preexisting condition.
| ||
Genetic information shall not be treated as a condition
| ||
described in subsection (A)(1) in the absence of a
diagnosis | ||
of the condition related to such
information.
| ||
(C) Rules relating to crediting previous coverage.
| ||
(1) Creditable coverage defined. For purposes of this
| ||
Act, the term "creditable coverage" means, with
respect to | ||
an individual, coverage of the individual
under any of the | ||
following:
| ||
(a) A group health plan.
|
(b) Health insurance coverage.
| ||
(c) Part A or part B of title XVIII of the Social | ||
Security
Act.
| ||
(d) Title XIX of the Social Security Act, other | ||
than coverage
consisting solely of benefits under | ||
Section 1928.
| ||
(e) Chapter 55 of title 10, United States Code.
| ||
(f) A medical care program of the Indian Health | ||
Service or of
a tribal organization.
| ||
(g) A State health benefits risk pool.
| ||
(h) A health plan offered under chapter 89 of | ||
title 5, United
States Code.
| ||
(i) A public health plan (as defined in | ||
regulations).
| ||
(j) A health benefit plan under Section 5(e) of | ||
the Peace
Corps Act (22 U.S.C. 2504(e)).
| ||
(k) Title XXI of the federal Social Security Act, | ||
State Children's
Health Insurance Program.
| ||
Such term does not include coverage consisting solely | ||
of
coverage of excepted benefits.
| ||
(2) Excepted benefits. For purposes of this Act, the | ||
term "excepted
benefits" means benefits under one or more | ||
of the following:
| ||
(a) Benefits not subject to requirements:
| ||
(i) Coverage only for accident, or disability | ||
income
insurance, or any combination thereof.
|
(ii) Coverage issued as a supplement to | ||
liability insurance.
| ||
(iii) Liability insurance, including general | ||
liability
insurance and automobile liability | ||
insurance.
| ||
(iv) Workers' compensation or similar | ||
insurance.
| ||
(v) Automobile medical payment insurance.
| ||
(vi) Credit-only insurance.
| ||
(vii) Coverage for on-site medical clinics.
| ||
(viii) Other similar insurance coverage, | ||
specified
in regulations, under which benefits for | ||
medical
care are secondary or incidental to other | ||
insurance
benefits.
| ||
(b) Benefits not subject to requirements if | ||
offered separately:
| ||
(i) Limited scope dental or vision benefits.
| ||
(ii) Benefits for long-term care, nursing home | ||
care, home
health care, community-based care, or | ||
any combination
thereof.
| ||
(iii) Such other similar, limited benefits as | ||
are
specified in rules.
| ||
(c) Benefits not subject to requirements if | ||
offered, as
independent, noncoordinated benefits:
| ||
(i) Coverage only for a specified disease or
| ||
illness.
|
(ii) Hospital indemnity or other fixed | ||
indemnity
insurance.
| ||
(d) Benefits not subject to requirements if | ||
offered as
separate insurance policy. Medicare | ||
supplemental health
insurance (as defined under | ||
Section 1882(g)(1) of the
Social Security Act), | ||
coverage supplemental to the
coverage provided under | ||
chapter 55 of title 10, United
States Code, and | ||
similar supplemental coverage provided to
coverage | ||
under a group health plan.
| ||
(3) Not counting periods before significant breaks in | ||
coverage.
| ||
(a) In general. A period of creditable coverage | ||
shall not
be counted, with respect to enrollment of an
| ||
individual under a group health plan, if, after such
| ||
period and before the enrollment date, there was a | ||
63-day period during all of
which the individual was | ||
not
covered under any creditable coverage.
| ||
(b) Waiting period not treated as a break in
| ||
coverage. For purposes of subparagraph (a) and
| ||
subsection (D)(3), any period that an individual is in
| ||
a waiting period for any coverage under a group health
| ||
plan (or for group health insurance coverage) or is in
| ||
an affiliation period (as defined in subsection
| ||
(G)(2)) shall not be taken into account in determining
| ||
the continuous period under subparagraph (a).
|
(4) (Blank). Method of crediting coverage.
| ||
(a) Standard method. Except as otherwise provided | ||
under
subparagraph (b), for purposes of applying | ||
subsection
(A)(3), a group health plan, and a health | ||
insurance
issuer offering group health insurance | ||
coverage, shall
count a period of creditable coverage | ||
without regard
to the specific benefits covered during | ||
the period.
| ||
(b) Election of alternative method. A group health | ||
plan,
or a health insurance issuer offering group | ||
health
insurance, may elect to apply subsection (A)(3) | ||
based
on coverage of benefits within each of several | ||
classes
or categories of benefits specified in | ||
regulations
rather than as provided under subparagraph | ||
(a). Such
election shall be made on a uniform basis for | ||
all
participants and beneficiaries. Under such | ||
election a
group health plan or issuer shall count a | ||
period of
creditable coverage with respect to any | ||
class or
category of benefits if any level of benefits | ||
is
covered within such class or category.
| ||
(c) Plan notice. In the case of an election with | ||
respect
to a group health plan under subparagraph (b) | ||
(whether
or not health insurance coverage is provided | ||
in
connection with such plan), the plan shall:
| ||
(i) prominently state in any disclosure | ||
statements
concerning the plan, and state to each |
enrollee at
the time of enrollment under the plan, | ||
that the
plan has made such election; and
| ||
(ii) include in such statements a description | ||
of
the effect of this election.
| ||
(d) Issuer notice. In the case of an election
| ||
under subparagraph (b) with respect to health
| ||
insurance coverage offered by an issuer in the small
| ||
or large group market, the issuer:
| ||
(i) shall prominently state in any disclosure
| ||
statements concerning the coverage, and to each
| ||
employer at the time of the offer or sale of the
| ||
coverage, that the issuer has made such election;
| ||
and
| ||
(ii) shall include in such statements a
| ||
description of the effect of such election.
| ||
(5) Establishment of period. Periods of creditable | ||
coverage
with respect to an individual shall be | ||
established through
presentation or certifications | ||
described in subsection (E)
or in such other manner as may | ||
be specified in
regulations.
| ||
(D) (Blank). Exceptions:
| ||
(1) Exclusion not applicable to certain newborns.
| ||
Subject to paragraph (3), a group health plan, and
a | ||
health insurance issuer offering group health
insurance | ||
coverage, may not impose any preexisting
condition | ||
exclusion in the case of an
individual who, as of the last |
day of the 30-day
period beginning with the date of birth, | ||
is
covered under creditable coverage.
| ||
(2) Exclusion not applicable to certain adopted
| ||
children. Subject to paragraph (3), a group
health plan, | ||
and a health insurance issuer
offering group health | ||
insurance coverage, may not
impose any preexisting | ||
condition exclusion in the
case of a child who is adopted | ||
or placed for
adoption before attaining 18 years of age | ||
and who,
as of the last day of the 30-day period beginning
| ||
on the date of the adoption or placement for
adoption, is | ||
covered under creditable coverage.
| ||
The previous sentence
shall not apply to coverage | ||
before the date of
such adoption or placement for | ||
adoption.
| ||
(3) Loss if break in coverage. Paragraphs (1) and
(2) | ||
shall no longer apply to an individual
after the end of the | ||
first 63-day period
during all of which the individual was | ||
not
covered under any creditable coverage.
| ||
(E) Certifications and disclosure of coverage.
| ||
(1) Requirement for Certification of Period of | ||
Creditable
Coverage.
| ||
(a) A group health plan, and a
health insurance | ||
issuer offering group health
insurance coverage, shall | ||
provide the certification described in subparagraph
| ||
(b):
| ||
(i) at the time an individual ceases to be |
covered
under the plan or otherwise becomes | ||
covered
under a COBRA continuation provision;
| ||
(ii) in the case of an individual becoming | ||
covered
under such a provision, at the time the
| ||
individual ceases to be covered under such
| ||
provision; and
| ||
(iii) on the request on behalf of an | ||
individual
made not later than 24 months after the | ||
date
of cessation of the coverage described in
| ||
clause (i) or (ii), whichever is later.
| ||
The certification under clause (i) may be provided, to
| ||
the extent practicable, at a time consistent with
| ||
notices required under any applicable COBRA
| ||
continuation provision.
| ||
(b) The certification described in
this | ||
subparagraph is a written certification of:
| ||
(i) the period of creditable coverage of the
| ||
individual under such plan and the coverage (if
| ||
any) under such COBRA continuation provision; and
| ||
(ii) the waiting period (if any) (and
| ||
affiliation period, if applicable) imposed with
| ||
respect to the individual for any coverage under
| ||
such plan.
| ||
(c) To the extent that medical care
under a group | ||
health plan consists of group health
insurance | ||
coverage, the plan is deemed to have
satisfied the |
certification requirement under this
paragraph if the | ||
health insurance issuer offering the
coverage provides | ||
for such certification in accordance
with this | ||
paragraph.
| ||
(2) (Blank). Disclosure of information on previous | ||
benefits. In the
case of an election described in | ||
subsection (C)(4)(b) by a
group health plan or health | ||
insurance issuer, if the plan
or issuer enrolls an | ||
individual for coverage under the
plan and the individual | ||
provides a certification of
coverage of the individual | ||
under paragraph (1):
| ||
(a) upon request of such plan or issuer, the | ||
entity which
issued the certification provided by the | ||
individual
shall promptly disclose to such requesting | ||
plan or
issuer information on coverage of classes and
| ||
categories of health benefits available under such
| ||
entity's plan or coverage; and
| ||
(b) such entity may charge the requesting plan or | ||
issuer
for the reasonable cost of disclosing such
| ||
information.
| ||
(3) Rules. The Department shall establish rules to
| ||
prevent an entity's failure to provide information under
| ||
paragraph (1) or (2) with respect to previous coverage of
| ||
an individual from adversely affecting any subsequent
| ||
coverage of the individual under another group health plan
| ||
or health insurance coverage.
|
(4) Treatment of certain plans as group health plan | ||
for
notice provision. A program under which creditable
| ||
coverage described in subparagraph (c), (d), (e), or
(f) | ||
of Section 20(C)(1) is provided shall be treated
as a | ||
group health plan for purposes of this Section.
| ||
(F) Special enrollment periods.
| ||
(1) Individuals losing other coverage. A group health
| ||
plan, and a health insurance issuer offering group
health | ||
insurance coverage in connection with a group health
plan, | ||
shall permit an employee who is eligible, but not
| ||
enrolled, for coverage under the terms of the plan (or a
| ||
dependent of such an employee if the dependent is | ||
eligible,
but not enrolled, for coverage under such terms) | ||
to enroll for
coverage under the terms of the plan if each | ||
of the following
conditions is met:
| ||
(a) The employee or dependent was covered under a
| ||
group health plan or had health insurance coverage
at | ||
the time coverage was previously offered to the
| ||
employee or dependent.
| ||
(b) The employee stated in writing at such time
| ||
that coverage under a group health plan or health
| ||
insurance coverage was the reason for declining
| ||
enrollment, but only if the plan sponsor or issuer
(if | ||
applicable) required such a statement at such
time and | ||
provided the employee with notice of such
requirement | ||
(and the consequences of such
requirement) at such |
time.
| ||
(c) The employee's or dependent's coverage
| ||
described in subparagraph (a):
| ||
(i) was under a COBRA continuation provision | ||
and the
coverage under such provision was | ||
exhausted; or
| ||
(ii) was not under such a provision and either | ||
the
coverage was terminated as a result of loss of
| ||
eligibility for the coverage (including as a
| ||
result of legal separation, divorce, death,
| ||
termination of employment, or reduction in the
| ||
number of hours of
employment) or employer | ||
contributions towards such
coverage were | ||
terminated.
| ||
(d) Under the terms of the plan, the employee
| ||
requests such enrollment not later than 30 days after
| ||
the date of exhaustion of coverage described in
| ||
subparagraph (c)(i) or termination of coverage or
| ||
employer contributions described in subparagraph
| ||
(c)(ii).
| ||
(2) For dependent beneficiaries.
| ||
(a) In general. If:
| ||
(i) a group health plan makes coverage
| ||
available with respect to a dependent of an
| ||
individual,
| ||
(ii) the individual is a participant under the |
plan (or
has met any waiting period applicable to | ||
becoming a
participant under the plan and is | ||
eligible to be
enrolled under the plan but for a | ||
failure to enroll
during a previous enrollment | ||
period), and
| ||
(iii) a person becomes such a dependent of the | ||
individual
through marriage, birth, or adoption or | ||
placement
for adoption,
| ||
then the group health plan shall provide
for a | ||
dependent special enrollment period described
in | ||
subparagraph (b) during which the person (or, if
not | ||
otherwise enrolled, the individual) may be
enrolled | ||
under the plan as a dependent of the
individual, and in | ||
the case of the birth or
adoption of a child, the | ||
spouse of the individual
may be enrolled as a | ||
dependent of the individual if
such spouse is | ||
otherwise eligible for coverage.
| ||
(b) Dependent special enrollment period. A
| ||
dependent special enrollment period under this
| ||
subparagraph shall be a period of not less than 30 days
| ||
and shall begin on the later of:
| ||
(i) the date dependent coverage is made
| ||
available; or
| ||
(ii) the date of the marriage, birth, or | ||
adoption or
placement for adoption (as the case | ||
may be)
described in subparagraph (a)(iii).
|
(c) No waiting period. If an individual seeks to | ||
enroll
a dependent during the first 30 days of such a
| ||
dependent special enrollment period, the coverage of
| ||
the dependent shall become effective:
| ||
(i) in the case of marriage, not later than | ||
the
first day of the first month beginning after | ||
the
date the completed request for enrollment is
| ||
received;
| ||
(ii) in the case of a dependent's birth, as of | ||
the
date of such birth; or
| ||
(iii) in the case of a dependent's adoption or
| ||
placement for adoption, the date of such
adoption | ||
or placement for adoption.
| ||
(G) Use of affiliation period by HMOs as alternative to | ||
preexisting
condition exclusion.
| ||
(1) In general. A health maintenance organization
| ||
which offers health insurance coverage in connection
with | ||
a group health plan and which does not impose any
| ||
pre-existing condition exclusion allowed under
subsection | ||
(A) with respect to any particular coverage
option may | ||
impose an affiliation period for such
coverage option, but | ||
only if:
| ||
(a) such period is applied uniformly without | ||
regard to
any health status-related factors; and
| ||
(b) such period does not exceed 2 months (or 3 | ||
months in
the case of a late enrollee).
|
(2) Affiliation period.
| ||
(a) Defined. For purposes of this Act, the term
| ||
"affiliation period" means a period which, under the
| ||
terms of the health insurance coverage offered by the
| ||
health maintenance organization, must expire before | ||
the
health insurance coverage becomes
effective. The | ||
organization is not required to
provide health care | ||
services or benefits during such
period and no premium | ||
shall be charged to the
participant or beneficiary for | ||
any coverage during
the period.
| ||
(b) Beginning. Such period shall begin on the
| ||
enrollment date.
| ||
(c) Runs concurrently with waiting periods. An
| ||
affiliation period under a plan shall run concurrently | ||
with any waiting period
under the plan.
| ||
(3) Alternative methods. A health maintenance | ||
organization
described in paragraph (1) may use | ||
alternative methods,
from those described in such | ||
paragraph, to address
adverse selection as approved by the | ||
Department.
| ||
(Source: P.A. 90-30, eff. 7-1-97; 90-736, eff. 8-12-98.)
| ||
Section 25. The Health Maintenance Organization Act is | ||
amended by changing Section 5-3 as follows:
| ||
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
|
Sec. 5-3. Insurance Code provisions.
| ||
(a) Health Maintenance Organizations
shall be subject to | ||
the provisions of Sections 133, 134, 136, 137, 139, 140, | ||
141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | ||
154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | ||
355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x, | ||
356y,
356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, | ||
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | ||
356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, | ||
356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, | ||
356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50, | ||
356z.51, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, | ||
368c, 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
| ||
408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of | ||
subsection (2) of Section 367, and Articles IIA, VIII 1/2,
| ||
XII,
XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the | ||
Illinois Insurance Code.
| ||
(b) For purposes of the Illinois Insurance Code, except | ||
for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | ||
Health Maintenance Organizations in
the following categories | ||
are deemed to be "domestic companies":
| ||
(1) a corporation authorized under the
Dental Service | ||
Plan Act or the Voluntary Health Services Plans Act;
| ||
(2) a corporation organized under the laws of this | ||
State; or
| ||
(3) a corporation organized under the laws of another |
state, 30% or more
of the enrollees of which are residents | ||
of this State, except a
corporation subject to | ||
substantially the same requirements in its state of
| ||
organization as is a "domestic company" under Article VIII | ||
1/2 of the
Illinois Insurance Code.
| ||
(c) In considering the merger, consolidation, or other | ||
acquisition of
control of a Health Maintenance Organization | ||
pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||
(1) the Director shall give primary consideration to | ||
the continuation of
benefits to enrollees and the | ||
financial conditions of the acquired Health
Maintenance | ||
Organization after the merger, consolidation, or other
| ||
acquisition of control takes effect;
| ||
(2)(i) the criteria specified in subsection (1)(b) of | ||
Section 131.8 of
the Illinois Insurance Code shall not | ||
apply and (ii) the Director, in making
his determination | ||
with respect to the merger, consolidation, or other
| ||
acquisition of control, need not take into account the | ||
effect on
competition of the merger, consolidation, or | ||
other acquisition of control;
| ||
(3) the Director shall have the power to require the | ||
following
information:
| ||
(A) certification by an independent actuary of the | ||
adequacy
of the reserves of the Health Maintenance | ||
Organization sought to be acquired;
| ||
(B) pro forma financial statements reflecting the |
combined balance
sheets of the acquiring company and | ||
the Health Maintenance Organization sought
to be | ||
acquired as of the end of the preceding year and as of | ||
a date 90 days
prior to the acquisition, as well as pro | ||
forma financial statements
reflecting projected | ||
combined operation for a period of 2 years;
| ||
(C) a pro forma business plan detailing an | ||
acquiring party's plans with
respect to the operation | ||
of the Health Maintenance Organization sought to
be | ||
acquired for a period of not less than 3 years; and
| ||
(D) such other information as the Director shall | ||
require.
| ||
(d) The provisions of Article VIII 1/2 of the Illinois | ||
Insurance Code
and this Section 5-3 shall apply to the sale by | ||
any health maintenance
organization of greater than 10% of its
| ||
enrollee population (including without limitation the health | ||
maintenance
organization's right, title, and interest in and | ||
to its health care
certificates).
| ||
(e) In considering any management contract or service | ||
agreement subject
to Section 141.1 of the Illinois Insurance | ||
Code, the Director (i) shall, in
addition to the criteria | ||
specified in Section 141.2 of the Illinois
Insurance Code, | ||
take into account the effect of the management contract or
| ||
service agreement on the continuation of benefits to enrollees | ||
and the
financial condition of the health maintenance | ||
organization to be managed or
serviced, and (ii) need not take |
into account the effect of the management
contract or service | ||
agreement on competition.
| ||
(f) Except for small employer groups as defined in the | ||
Small Employer
Rating, Renewability and Portability Health | ||
Insurance Act and except for
medicare supplement policies as | ||
defined in Section 363 of the Illinois
Insurance Code, a | ||
Health Maintenance Organization may by contract agree with a
| ||
group or other enrollment unit to effect refunds or charge | ||
additional premiums
under the following terms and conditions:
| ||
(i) the amount of, and other terms and conditions with | ||
respect to, the
refund or additional premium are set forth | ||
in the group or enrollment unit
contract agreed in advance | ||
of the period for which a refund is to be paid or
| ||
additional premium is to be charged (which period shall | ||
not be less than one
year); and
| ||
(ii) the amount of the refund or additional premium | ||
shall not exceed 20%
of the Health Maintenance | ||
Organization's profitable or unprofitable experience
with | ||
respect to the group or other enrollment unit for the | ||
period (and, for
purposes of a refund or additional | ||
premium, the profitable or unprofitable
experience shall | ||
be calculated taking into account a pro rata share of the
| ||
Health Maintenance Organization's administrative and | ||
marketing expenses, but
shall not include any refund to be | ||
made or additional premium to be paid
pursuant to this | ||
subsection (f)). The Health Maintenance Organization and |
the
group or enrollment unit may agree that the profitable | ||
or unprofitable
experience may be calculated taking into | ||
account the refund period and the
immediately preceding 2 | ||
plan years.
| ||
The Health Maintenance Organization shall include a | ||
statement in the
evidence of coverage issued to each enrollee | ||
describing the possibility of a
refund or additional premium, | ||
and upon request of any group or enrollment unit,
provide to | ||
the group or enrollment unit a description of the method used | ||
to
calculate (1) the Health Maintenance Organization's | ||
profitable experience with
respect to the group or enrollment | ||
unit and the resulting refund to the group
or enrollment unit | ||
or (2) the Health Maintenance Organization's unprofitable
| ||
experience with respect to the group or enrollment unit and | ||
the resulting
additional premium to be paid by the group or | ||
enrollment unit.
| ||
In no event shall the Illinois Health Maintenance | ||
Organization
Guaranty Association be liable to pay any | ||
contractual obligation of an
insolvent organization to pay any | ||
refund authorized under this Section.
| ||
(g) Rulemaking authority to implement Public Act 95-1045, | ||
if any, is conditioned on the rules being adopted in | ||
accordance with all provisions of the Illinois Administrative | ||
Procedure Act and all rules and procedures of the Joint | ||
Committee on Administrative Rules; any purported rule not so | ||
adopted, for whatever reason, is unauthorized. |
(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | ||
101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. | ||
1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, | ||
eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | ||
eff. 10-8-21; revised 10-27-21.) | ||
Section 30. The Limited Health Service Organization Act is | ||
amended by changing Section 4003 as follows:
| ||
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| ||
Sec. 4003. Illinois Insurance Code provisions. Limited | ||
health service
organizations shall be subject to the | ||
provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, | ||
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | ||
154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, | ||
355b, 356q, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, | ||
356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.46, | ||
356z.47, 356z.51, 364.3, 356z.43, 368a, 401, 401.1,
402,
403, | ||
403A, 408,
408.2, 409, 412, 444, and 444.1 and Articles IIA, | ||
VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the | ||
Illinois Insurance Code. For purposes of the
Illinois | ||
Insurance Code, except for Sections 444 and 444.1 and Articles | ||
XIII
and XIII 1/2, limited health service organizations in the | ||
following categories
are deemed to be domestic companies:
|
(1) a corporation under the laws of this State; or
| ||
(2) a corporation organized under the laws of another | ||
state, 30% or more
of the enrollees of which are residents | ||
of this State, except a corporation
subject to | ||
substantially the same requirements in its state of | ||
organization as
is a domestic company under Article VIII | ||
1/2 of the Illinois Insurance Code.
| ||
(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||
101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. | ||
1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, | ||
eff. 1-1-22; revised 10-27-21.)
| ||
Section 35. The Voluntary Health Services Plans Act is | ||
amended by changing Section 10 as follows:
| ||
(215 ILCS 165/10) (from Ch. 32, par. 604)
| ||
Sec. 10. Application of Insurance Code provisions. Health | ||
services
plan corporations and all persons interested therein | ||
or dealing therewith
shall be subject to the provisions of | ||
Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | ||
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | ||
356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v,
356w, | ||
356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, | ||
356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | ||
356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, | ||
356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40, |
356z.41, 356z.46, 356z.47, 356z.51, 356z.43, 364.01, 364.3, | ||
367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | ||
and paragraphs (7) and (15) of Section 367 of the Illinois
| ||
Insurance Code.
| ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | ||
101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. | ||
1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, | ||
eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; | ||
revised 10-27-21.) | ||
Section 40. The Workers' Compensation Act is amended by
| ||
changing Section 19 as follows:
| ||
(820 ILCS 305/19) (from Ch. 48, par. 138.19)
| ||
Sec. 19. Any disputed questions of law or fact shall be | ||
determined
as herein provided.
| ||
(a) It shall be the duty of the Commission upon | ||
notification that
the parties have failed to reach an | ||
agreement, to designate an Arbitrator.
| ||
1. Whenever any claimant misconceives his remedy and |
files an
application for adjustment of claim under this | ||
Act and it is
subsequently discovered, at any time before | ||
final disposition of such
cause, that the claim for | ||
disability or death which was the basis for
such | ||
application should properly have been made under the | ||
Workers'
Occupational Diseases Act, then the provisions of | ||
Section 19, paragraph
(a-1) of the Workers' Occupational | ||
Diseases Act having reference to such
application shall | ||
apply.
| ||
2. Whenever any claimant misconceives his remedy and | ||
files an
application for adjustment of claim under the | ||
Workers' Occupational
Diseases Act and it is subsequently | ||
discovered, at any time before final
disposition of such | ||
cause that the claim for injury or death which was
the | ||
basis for such application should properly have been made | ||
under this
Act, then the application so filed under the | ||
Workers' Occupational
Diseases Act may be amended in form, | ||
substance or both to assert claim
for such disability or | ||
death under this Act and it shall be deemed to
have been so | ||
filed as amended on the date of the original filing
| ||
thereof, and such compensation may be awarded as is | ||
warranted by the
whole evidence pursuant to this Act. When | ||
such amendment is submitted,
further or additional | ||
evidence may be heard by the Arbitrator or
Commission when | ||
deemed necessary. Nothing in this Section contained
shall | ||
be construed to be or permit a waiver of any provisions of |
this
Act with reference to notice but notice if given | ||
shall be deemed to be a
notice under the provisions of this | ||
Act if given within the time
required herein.
| ||
(b) The Arbitrator shall make such inquiries and | ||
investigations as he or
they shall deem necessary and may | ||
examine and inspect all books, papers,
records, places, or | ||
premises relating to the questions in dispute and hear
such | ||
proper evidence as the parties may submit.
| ||
The hearings before the Arbitrator shall be held in the | ||
vicinity where
the injury occurred after 10 days' notice of | ||
the time and place of such
hearing shall have been given to | ||
each of the parties or their attorneys
of record.
| ||
The Arbitrator may find that the disabling condition is | ||
temporary and has
not yet reached a permanent condition and | ||
may order the payment of
compensation up to the date of the | ||
hearing, which award shall be reviewable
and enforceable in | ||
the same manner as other awards, and in no instance be a
bar to | ||
a further hearing and determination of a further amount of | ||
temporary
total compensation or of compensation for permanent | ||
disability, but shall
be conclusive as to all other questions | ||
except the nature and extent of said
disability.
| ||
The decision of the Arbitrator shall be filed with the | ||
Commission which
Commission shall immediately send to each | ||
party or his attorney a copy of
such decision, together with a | ||
notification of the time when it was filed.
As of the effective | ||
date of this amendatory Act of the 94th General Assembly, all |
decisions of the Arbitrator shall set forth
in writing | ||
findings of fact and conclusions of law, separately stated, if | ||
requested by either party.
Unless a petition for review is | ||
filed by either party within 30 days after
the receipt by such | ||
party of the copy of the decision and notification of
time when | ||
filed, and unless such party petitioning for a review shall
| ||
within 35 days after the receipt by him of the copy of the | ||
decision, file
with the Commission either an agreed statement | ||
of the facts appearing upon
the hearing before the Arbitrator, | ||
or if such
party shall so elect a correct transcript of | ||
evidence of the proceedings
at such hearings, then the | ||
decision shall become the decision of the
Commission and in | ||
the absence of fraud shall be conclusive.
The Petition for | ||
Review shall contain a statement of the petitioning party's
| ||
specific exceptions to the decision of the arbitrator. The | ||
jurisdiction
of the Commission to review the decision of the | ||
arbitrator shall not be
limited to the exceptions stated in | ||
the Petition for Review.
The Commission, or any member | ||
thereof, may grant further time not exceeding
30 days, in | ||
which to file such agreed statement or transcript of
evidence. | ||
Such agreed statement of facts or correct transcript of
| ||
evidence, as the case may be, shall be authenticated by the | ||
signatures
of the parties or their attorneys, and in the event | ||
they do not agree as
to the correctness of the transcript of | ||
evidence it shall be authenticated
by the signature of the | ||
Arbitrator designated by the Commission.
|
Whether the employee is working or not, if the employee is | ||
not receiving or has not received medical, surgical, or | ||
hospital services or other services or compensation as | ||
provided in paragraph (a) of Section 8, or compensation as | ||
provided in paragraph (b) of Section 8, the employee may at any | ||
time petition for an expedited hearing by an Arbitrator on the | ||
issue of whether or not he or she is entitled to receive | ||
payment of the services or compensation. Provided the employer | ||
continues to pay compensation pursuant to paragraph (b) of | ||
Section 8, the employer may at any time petition for an | ||
expedited hearing on the issue of whether or not the employee | ||
is entitled to receive medical, surgical, or hospital services | ||
or other services or compensation as provided in paragraph (a) | ||
of Section 8, or compensation as provided in paragraph (b) of | ||
Section 8. When an employer has petitioned for an expedited | ||
hearing, the employer shall continue to pay compensation as | ||
provided in paragraph (b) of Section 8 unless the arbitrator | ||
renders a decision that the employee is not entitled to the | ||
benefits that are the subject of the expedited hearing or | ||
unless the employee's treating physician has released the | ||
employee to return to work at his or her regular job with the | ||
employer or the employee actually returns to work at any other | ||
job. If the arbitrator renders a decision that the employee is | ||
not entitled to the benefits that are the subject of the | ||
expedited hearing, a petition for review filed by the employee | ||
shall receive the same priority as if the employee had filed a |
petition for an expedited hearing by an Arbitrator. Neither | ||
party shall be entitled to an expedited hearing when the | ||
employee has returned to work and the sole issue in dispute | ||
amounts to less than 12 weeks of unpaid compensation pursuant | ||
to paragraph (b) of Section 8. | ||
Expedited hearings shall have priority over all other | ||
petitions and shall be heard by the Arbitrator and Commission | ||
with all convenient speed. Any party requesting an expedited | ||
hearing shall give notice of a request for an expedited | ||
hearing under this paragraph. A copy of the Application for | ||
Adjustment of Claim shall be attached to the notice. The | ||
Commission shall adopt rules and procedures under which the | ||
final decision of the Commission under this paragraph is filed | ||
not later than 180 days from the date that the Petition for | ||
Review is filed with the Commission. | ||
Where 2 or more insurance carriers, private self-insureds, | ||
or a group workers' compensation pool under Article V 3/4 of | ||
the Illinois Insurance Code dispute coverage for the same | ||
injury, any such insurance carrier, private self-insured, or | ||
group workers' compensation pool may request an expedited | ||
hearing pursuant to this paragraph to determine the issue of | ||
coverage, provided coverage is the only issue in dispute and | ||
all other issues are stipulated and agreed to and further | ||
provided that all compensation benefits including medical | ||
benefits pursuant to Section 8(a) continue to be paid to or on | ||
behalf of petitioner. Any insurance carrier, private |
self-insured, or group workers' compensation pool that is | ||
determined to be liable for coverage for the injury in issue | ||
shall reimburse any insurance carrier, private self-insured, | ||
or group workers' compensation pool that has paid benefits to | ||
or on behalf of petitioner for the injury.
| ||
(b-1) If the employee is not receiving medical, surgical | ||
or hospital
services as provided in paragraph (a) of Section 8 | ||
or compensation as
provided in paragraph (b) of Section 8, the | ||
employee, in accordance with
Commission Rules, may file a | ||
petition for an emergency hearing by an
Arbitrator on the | ||
issue of whether or not he is entitled to receive payment
of | ||
such compensation or services as provided therein. Such | ||
petition shall
have priority over all other petitions and | ||
shall be heard by the Arbitrator
and Commission with all | ||
convenient speed.
| ||
Such petition shall contain the following information and | ||
shall be served
on the employer at least 15 days before it is | ||
filed:
| ||
(i) the date and approximate time of accident;
| ||
(ii) the approximate location of the accident;
| ||
(iii) a description of the accident;
| ||
(iv) the nature of the injury incurred by the | ||
employee;
| ||
(v) the identity of the person, if known, to whom the | ||
accident was
reported and the date on which it was | ||
reported;
|
(vi) the name and title of the person, if known, | ||
representing the
employer with whom the employee conferred | ||
in any effort to obtain
compensation pursuant to paragraph | ||
(b) of Section 8 of this Act or medical,
surgical or | ||
hospital services pursuant to paragraph (a) of Section 8 | ||
of
this Act and the date of such conference;
| ||
(vii) a statement that the employer has refused to pay | ||
compensation
pursuant to paragraph (b) of Section 8 of | ||
this Act or for medical, surgical
or hospital services | ||
pursuant to paragraph (a) of Section 8 of this Act;
| ||
(viii) the name and address, if known, of each witness | ||
to the accident
and of each other person upon whom the | ||
employee will rely to support his
allegations;
| ||
(ix) the dates of treatment related to the accident by | ||
medical
practitioners, and the names and addresses of such | ||
practitioners, including
the dates of treatment related to | ||
the accident at any hospitals and the
names and addresses | ||
of such hospitals, and a signed authorization
permitting | ||
the employer to examine all medical records of all | ||
practitioners
and hospitals named pursuant to this | ||
paragraph;
| ||
(x) a copy of a signed report by a medical | ||
practitioner, relating to the
employee's current inability | ||
to return to work because of the injuries
incurred as a | ||
result of the accident or such other documents or | ||
affidavits
which show that the employee is entitled to |
receive compensation pursuant
to paragraph (b) of Section | ||
8 of this Act or medical, surgical or hospital
services | ||
pursuant to paragraph (a) of Section 8 of this Act. Such | ||
reports,
documents or affidavits shall state, if possible, | ||
the history of the
accident given by the employee, and | ||
describe the injury and medical
diagnosis, the medical | ||
services for such injury which the employee has
received | ||
and is receiving, the physical activities which the | ||
employee
cannot currently perform as a result of any | ||
impairment or disability due to
such injury, and the | ||
prognosis for recovery;
| ||
(xi) complete copies of any reports, records, | ||
documents and affidavits
in the possession of the employee | ||
on which the employee will rely to
support his | ||
allegations, provided that the employer shall pay the
| ||
reasonable cost of reproduction thereof;
| ||
(xii) a list of any reports, records, documents and | ||
affidavits which
the employee has demanded by subpoena and | ||
on which he intends to
rely to support his allegations;
| ||
(xiii) a certification signed by the employee or his | ||
representative that
the employer has received the petition | ||
with the required information 15
days before filing.
| ||
Fifteen days after receipt by the employer of the petition | ||
with the
required information the employee may file said | ||
petition and required
information and shall serve notice of | ||
the filing upon the employer. The
employer may file a motion |
addressed to the sufficiency of the petition.
If an objection | ||
has been filed to the sufficiency of the petition, the
| ||
arbitrator shall rule on the objection within 2 working days. | ||
If such an
objection is filed, the time for filing the final | ||
decision of the
Commission as provided in this paragraph shall | ||
be tolled until the
arbitrator has determined that the | ||
petition is sufficient.
| ||
The employer shall, within 15 days after receipt of the | ||
notice that such
petition is filed, file with the Commission | ||
and serve on the employee or
his representative a written | ||
response to each claim set forth in the
petition, including | ||
the legal and factual basis for each disputed
allegation and | ||
the following information: (i) complete copies of any
reports, | ||
records, documents and affidavits in the possession of the
| ||
employer on which the employer intends to rely in support of | ||
his response,
(ii) a list of any reports, records, documents | ||
and affidavits which the
employer has demanded by subpoena and | ||
on which the employer intends to rely
in support of his | ||
response, (iii) the name and address of each witness on
whom | ||
the employer will rely to support his response, and (iv) the | ||
names and
addresses of any medical practitioners selected by | ||
the employer pursuant to
Section 12 of this Act and the time | ||
and place of any examination scheduled
to be made pursuant to | ||
such Section.
| ||
Any employer who does not timely file and serve a written | ||
response
without good cause may not introduce any evidence to |
dispute any claim of
the employee but may cross examine the | ||
employee or any witness brought by
the employee and otherwise | ||
be heard.
| ||
No document or other evidence not previously identified by | ||
either party
with the petition or written response, or by any | ||
other means before the
hearing, may be introduced into | ||
evidence without good cause.
If, at the hearing, material | ||
information is discovered which was
not previously disclosed, | ||
the Arbitrator may extend the time for closing
proof on the | ||
motion of a party for a reasonable period of time which may
be | ||
more than 30 days. No evidence may be introduced pursuant
to | ||
this paragraph as to permanent disability. No award may be | ||
entered for
permanent disability pursuant to this paragraph. | ||
Either party may introduce
into evidence the testimony taken | ||
by deposition of any medical practitioner.
| ||
The Commission shall adopt rules, regulations and | ||
procedures whereby the
final decision of the Commission is | ||
filed not later than 90 days from the
date the petition for | ||
review is filed but in no event later than 180 days from
the | ||
date the petition for an emergency hearing is filed with the | ||
Illinois Workers' Compensation
Commission.
| ||
All service required pursuant to this paragraph (b-1) must | ||
be by personal
service or by certified mail and with evidence | ||
of receipt. In addition for
the purposes of this paragraph, | ||
all service on the employer must be at the
premises where the | ||
accident occurred if the premises are owned or operated
by the |
employer. Otherwise service must be at the employee's | ||
principal
place of employment by the employer. If service on | ||
the employer is not
possible at either of the above, then | ||
service shall be at the employer's
principal place of | ||
business. After initial service in each case, service
shall be | ||
made on the employer's attorney or designated representative.
| ||
(c)(1) At a reasonable time in advance of and in | ||
connection with the
hearing under Section 19(e) or 19(h), the | ||
Commission may on its own motion
order an impartial physical | ||
or mental examination of a petitioner whose
mental or physical | ||
condition is in issue, when in the Commission's
discretion it | ||
appears that such an examination will materially aid in the
| ||
just determination of the case. The examination shall be made | ||
by a member
or members of a panel of physicians chosen for | ||
their special qualifications
by the Illinois State Medical | ||
Society. The Commission shall establish
procedures by which a | ||
physician shall be selected from such list.
| ||
(2) Should the Commission at any time during the hearing | ||
find that
compelling considerations make it advisable to have | ||
an examination and
report at that time, the commission may in | ||
its discretion so order.
| ||
(3) A copy of the report of examination shall be given to | ||
the Commission
and to the attorneys for the parties.
| ||
(4) Either party or the Commission may call the examining | ||
physician or
physicians to testify. Any physician so called | ||
shall be subject to
cross-examination.
|
(5) The examination shall be made, and the physician or | ||
physicians, if
called, shall testify, without cost to the | ||
parties. The Commission shall
determine the compensation and | ||
the pay of the physician or physicians. The
compensation for | ||
this service shall not exceed the usual and customary amount
| ||
for such service.
| ||
(6) The fees and payment thereof of all attorneys and | ||
physicians for
services authorized by the Commission under | ||
this Act shall, upon request
of either the employer or the | ||
employee or the beneficiary affected, be
subject to the review | ||
and decision of the Commission.
| ||
(d) If any employee shall persist in insanitary or | ||
injurious
practices which tend to either imperil or retard his | ||
recovery or shall
refuse to submit to such medical, surgical, | ||
or hospital treatment as is
reasonably essential to promote | ||
his recovery, the Commission may, in its
discretion, reduce or | ||
suspend the compensation of any such injured
employee. | ||
However, when an employer and employee so agree in writing,
| ||
the foregoing provision shall not be construed to authorize | ||
the
reduction or suspension of compensation of an employee who | ||
is relying in
good faith, on treatment by prayer or spiritual | ||
means alone, in
accordance with the tenets and practice of a | ||
recognized church or
religious denomination, by a duly | ||
accredited practitioner thereof.
| ||
(e) This paragraph shall apply to all hearings before the | ||
Commission.
Such hearings may be held in its office or |
elsewhere as the Commission
may deem advisable. The taking of | ||
testimony on such hearings may be had
before any member of the | ||
Commission. If a petition for review and agreed
statement of | ||
facts or transcript of evidence is filed, as provided herein,
| ||
the Commission shall promptly review the decision of the | ||
Arbitrator and all
questions of law or fact which appear from | ||
the statement of facts or
transcript of evidence.
| ||
In all cases in which the hearing before the arbitrator is | ||
held after
December 18, 1989, no additional evidence shall be | ||
introduced by the
parties before the Commission on review of | ||
the decision of the Arbitrator.
In reviewing decisions of an | ||
arbitrator the Commission shall award such
temporary | ||
compensation, permanent compensation and other payments as are
| ||
due under this Act. The Commission shall file in its office its | ||
decision
thereon, and shall immediately send to each party or | ||
his attorney a copy of
such decision and a notification of the | ||
time when it was filed. Decisions
shall be filed within 60 days | ||
after the Statement of Exceptions and
Supporting Brief and | ||
Response thereto are required to be filed or oral
argument | ||
whichever is later.
| ||
In the event either party requests oral argument, such | ||
argument shall be
had before a panel of 3 members of the | ||
Commission (or before all available
members pursuant to the | ||
determination of 7 members of the Commission that
such | ||
argument be held before all available members of the | ||
Commission)
pursuant to the rules and regulations of the |
Commission. A panel of 3
members, which shall be comprised of | ||
not more than one representative
citizen of the employing | ||
class and not more than one representative from a labor | ||
organization recognized under the National Labor Relations Act | ||
or an attorney who has represented labor organizations or has | ||
represented employees in workers' compensation cases, shall | ||
hear the argument; provided that if all the
issues in dispute | ||
are solely the nature and extent of the permanent partial
| ||
disability, if any, a majority of the panel may deny the | ||
request for such
argument and such argument shall not be held; | ||
and provided further that 7
members of the Commission may | ||
determine that the argument be held before
all available | ||
members of the Commission. A decision of the Commission
shall | ||
be approved by a majority of Commissioners present at such | ||
hearing if
any; provided, if no such hearing is held, a | ||
decision of the Commission
shall be approved by a majority of a | ||
panel of 3 members of the Commission
as described in this | ||
Section. The Commission shall give 10 days' notice to
the | ||
parties or their attorneys of the time and place of such taking | ||
of
testimony and of such argument.
| ||
In any case the Commission in its decision may find | ||
specially
upon any question or questions of law or fact which | ||
shall be submitted
in writing by either party whether ultimate | ||
or otherwise;
provided that on issues other than nature and | ||
extent of the disability,
if any, the Commission in its | ||
decision shall find specially upon any
question or questions |
of law or fact, whether ultimate or otherwise,
which are | ||
submitted in writing by either party; provided further that
| ||
not more than 5 such questions may be submitted by either | ||
party. Any
party may, within 20 days after receipt of notice of | ||
the Commission's
decision, or within such further time, not | ||
exceeding 30 days, as the
Commission may grant, file with the | ||
Commission either an agreed
statement of the facts appearing | ||
upon the hearing, or, if such party
shall so elect, a correct | ||
transcript of evidence of the additional
proceedings presented | ||
before the Commission, in which report the party
may embody a | ||
correct statement of such other proceedings in the case as
| ||
such party may desire to have reviewed, such statement of | ||
facts or
transcript of evidence to be authenticated by the | ||
signature of the
parties or their attorneys, and in the event | ||
that they do not agree,
then the authentication of such | ||
transcript of evidence shall be by the
signature of any member | ||
of the Commission.
| ||
If a reporter does not for any reason furnish a transcript | ||
of the
proceedings before the Arbitrator in any case for use on | ||
a hearing for
review before the Commission, within the | ||
limitations of time as fixed in
this Section, the Commission | ||
may, in its discretion, order a trial de
novo before the | ||
Commission in such case upon application of either
party. The | ||
applications for adjustment of claim and other documents in
| ||
the nature of pleadings filed by either party, together with | ||
the
decisions of the Arbitrator and of the Commission and the |
statement of
facts or transcript of evidence hereinbefore | ||
provided for in paragraphs
(b) and (c) shall be the record of | ||
the proceedings of the Commission,
and shall be subject to | ||
review as hereinafter provided.
| ||
At the request of either party or on its own motion, the | ||
Commission shall
set forth in writing the reasons for the | ||
decision, including findings of
fact and conclusions of law | ||
separately stated. The Commission shall by rule
adopt a format | ||
for written decisions for the Commission and arbitrators.
The | ||
written decisions shall be concise and shall succinctly state | ||
the facts
and reasons for the decision. The Commission may | ||
adopt in whole or in part,
the decision of the arbitrator as | ||
the decision of the Commission. When the
Commission does so | ||
adopt the decision of the arbitrator, it shall do so by
order. | ||
Whenever the Commission adopts part of the arbitrator's | ||
decision,
but not all, it shall include in the order the | ||
reasons for not adopting all
of the arbitrator's decision. | ||
When a majority of a panel, after
deliberation, has arrived at | ||
its decision, the decision shall be filed as
provided in this | ||
Section without unnecessary delay, and without regard to
the | ||
fact that a member of the panel has expressed an intention to | ||
dissent.
Any member of the panel may file a dissent. Any | ||
dissent shall be filed no
later than 10 days after the decision | ||
of the majority has been filed.
| ||
Decisions rendered by the Commission and dissents, if any, | ||
shall be
published together by the Commission. The conclusions |
of law set out in
such decisions shall be regarded as | ||
precedents by arbitrators for the purpose
of achieving a more | ||
uniform administration of this Act.
| ||
(f) The decision of the Commission acting within its | ||
powers,
according to the provisions of paragraph (e) of this | ||
Section shall, in
the absence of fraud, be conclusive unless | ||
reviewed as in this paragraph
hereinafter provided. However, | ||
the Arbitrator or the Commission may on
his or its own motion, | ||
or on the motion of either party, correct any
clerical error or | ||
errors in computation within 15 days after the date of
receipt | ||
of any award by such Arbitrator or any decision on review of | ||
the
Commission and shall have the power to recall the original | ||
award on
arbitration or decision on review, and issue in lieu | ||
thereof such
corrected award or decision. Where such | ||
correction is made the time for
review herein specified shall | ||
begin to run from the date of
the receipt of the corrected | ||
award or decision.
| ||
(1) Except in cases of claims against the State of | ||
Illinois other than those claims under Section 18.1, in
| ||
which case the decision of the Commission shall not be | ||
subject to
judicial review, the Circuit Court of the | ||
county where any of the
parties defendant may be found, or | ||
if none of the parties defendant can
be found in this State | ||
then the Circuit Court of the county where the
accident | ||
occurred, shall by summons to the Commission have
power to | ||
review all questions of law and fact presented by such |
record.
| ||
A proceeding for review shall be commenced within 20 | ||
days of
the receipt of notice of the decision of the | ||
Commission. The summons shall
be issued by the clerk of | ||
such court upon written request returnable on a
designated | ||
return day, not less than 10 or more than 60 days from the | ||
date
of issuance thereof, and the written request shall | ||
contain the last known
address of other parties in | ||
interest and their attorneys of record who are
to be | ||
served by summons. Service upon any member of the | ||
Commission or the
Secretary or the Assistant Secretary | ||
thereof shall be service upon the
Commission, and service | ||
upon other parties in interest and their attorneys
of | ||
record shall be by summons, and such service shall be made | ||
upon the
Commission and other parties in interest by | ||
mailing notices of the
commencement of the proceedings and | ||
the return day of the summons to the
office of the | ||
Commission and to the last known place of residence of | ||
other
parties in interest or their attorney or attorneys | ||
of record. The clerk of
the court issuing the summons | ||
shall on the day of issue mail notice of the
commencement | ||
of the proceedings which shall be done by mailing a copy of
| ||
the summons to the office of the Commission, and a copy of | ||
the summons to
the other parties in interest or their | ||
attorney or attorneys of record and
the clerk of the court | ||
shall make certificate that he has so sent said
notices in |
pursuance of this Section, which shall be evidence of | ||
service on
the Commission and other parties in interest.
| ||
The Commission shall not be required to certify the | ||
record of their
proceedings to the Circuit Court, unless | ||
the party commencing the
proceedings for review in the | ||
Circuit Court as above provided, shall file with the | ||
Commission notice of intent to file for review in Circuit | ||
Court. It shall be the duty
of the Commission upon such | ||
filing of notice of intent to file for review in the | ||
Circuit Court to prepare a true and correct
copy of such | ||
testimony and a true and correct copy of all other matters
| ||
contained in such record and certified to by the Secretary | ||
or Assistant
Secretary thereof. The changes made to this | ||
subdivision (f)(1) by this amendatory Act of the 98th | ||
General Assembly apply to any Commission decision entered | ||
after the effective date of this amendatory Act of the | ||
98th General Assembly.
| ||
No request for a summons
may be filed and no summons | ||
shall issue unless the party seeking to review
the | ||
decision of the Commission shall exhibit to the clerk of | ||
the Circuit
Court proof of filing with the Commission of | ||
the notice of the intent to file for review in the Circuit | ||
Court or an affidavit
of the attorney setting forth that | ||
notice of intent to file for review in the Circuit Court | ||
has been given in writing to the Secretary or Assistant | ||
Secretary of the Commission.
|
(2) No such summons shall issue unless the one against | ||
whom the
Commission shall have rendered an award for the | ||
payment of money shall upon
the filing of his written | ||
request for such summons file with the clerk of
the court a | ||
bond conditioned that if he shall not successfully
| ||
prosecute the review, he will pay the award and the costs | ||
of the
proceedings in the courts. The amount of the bond | ||
shall be fixed by any
member of the Commission and the | ||
surety or sureties of the bond shall be
approved by the | ||
clerk of the court. The acceptance of the bond by the
clerk | ||
of the court shall constitute evidence of his approval of | ||
the bond.
| ||
The following Every county, city, town, township, | ||
incorporated village, school
district, body politic or | ||
municipal corporation against whom the
Commission shall | ||
have rendered an award for the payment of money shall
not | ||
be required to file a bond to secure the payment of the | ||
award and
the costs of the proceedings in the court to | ||
authorize the court to
issue such summons : .
| ||
(1) the State Treasurer, for a fund administered | ||
by the State Treasurer ex officio against whom the | ||
Commission shall have rendered an award for the | ||
payment of money; and | ||
(2) a county, city, town, township, incorporated | ||
village, school district, body politic, or municipal | ||
corporation against whom the Commission shall have |
rendered an award for the payment of money. | ||
The court may confirm or set aside the decision of the | ||
Commission. If
the decision is set aside and the facts | ||
found in the proceedings before
the Commission are | ||
sufficient, the court may enter such decision as is
| ||
justified by law, or may remand the cause to the | ||
Commission for further
proceedings and may state the | ||
questions requiring further hearing, and
give such other | ||
instructions as may be proper. Appeals shall be taken
to | ||
the Appellate Court in accordance
with Supreme Court Rules | ||
22(g) and 303. Appeals
shall be taken from the Appellate
| ||
Court to the Supreme Court in accordance with Supreme | ||
Court Rule 315.
| ||
It shall be the duty of the clerk of any court | ||
rendering a decision
affecting or affirming an award of | ||
the Commission to promptly furnish
the Commission with a | ||
copy of such decision, without charge.
| ||
The decision of a majority of the members of the panel | ||
of the Commission,
shall be considered the decision of the | ||
Commission.
| ||
(g) Except in the case of a claim against the State of | ||
Illinois,
either party may present a certified copy of the | ||
award of the
Arbitrator, or a certified copy of the decision of | ||
the Commission when
the same has become final, when no | ||
proceedings for review are pending,
providing for the payment | ||
of compensation according to this Act, to the
Circuit Court of |
the county in which such accident occurred or either of
the | ||
parties are residents, whereupon the court shall enter a | ||
judgment
in accordance therewith. In a case where the employer | ||
refuses to pay
compensation according to such final award or | ||
such final decision upon
which such judgment is entered the | ||
court shall in entering judgment
thereon, tax as costs against | ||
him the reasonable costs and attorney fees
in the arbitration | ||
proceedings and in the court entering the judgment
for the | ||
person in whose favor the judgment is entered, which judgment
| ||
and costs taxed as therein provided shall, until and unless | ||
set aside,
have the same effect as though duly entered in an | ||
action duly tried and
determined by the court, and shall with | ||
like effect, be entered and
docketed. The Circuit Court shall | ||
have power at any time upon
application to make any such | ||
judgment conform to any modification
required by any | ||
subsequent decision of the Supreme Court upon appeal, or
as | ||
the result of any subsequent proceedings for review, as | ||
provided in
this Act.
| ||
Judgment shall not be entered until 15 days' notice of the | ||
time and
place of the application for the entry of judgment | ||
shall be served upon
the employer by filing such notice with | ||
the Commission, which Commission
shall, in case it has on file | ||
the address of the employer or the name
and address of its | ||
agent upon whom notices may be served, immediately
send a copy | ||
of the notice to the employer or such designated agent.
| ||
(h) An agreement or award under this Act providing for |
compensation
in installments, may at any time within 18 months | ||
after such agreement
or award be reviewed by the Commission at | ||
the request of either the
employer or the employee, on the | ||
ground that the disability of the
employee has subsequently | ||
recurred, increased, diminished or ended.
| ||
However, as to accidents occurring subsequent to July 1, | ||
1955, which
are covered by any agreement or award under this | ||
Act providing for
compensation in installments made as a | ||
result of such accident, such
agreement or award may at any | ||
time within 30 months, or 60 months in the case of an award | ||
under Section 8(d)1, after such agreement
or award be reviewed | ||
by the Commission at the request of either the
employer or the | ||
employee on the ground that the disability of the
employee has | ||
subsequently recurred, increased, diminished or ended.
| ||
On such review, compensation payments may be | ||
re-established,
increased, diminished or ended. The Commission | ||
shall give 15 days'
notice to the parties of the hearing for | ||
review. Any employee, upon any
petition for such review being | ||
filed by the employer, shall be entitled
to one day's notice | ||
for each 100 miles necessary to be traveled by him in
attending | ||
the hearing of the Commission upon the petition, and 3 days in
| ||
addition thereto. Such employee shall, at the discretion of | ||
the
Commission, also be entitled to 5 cents per mile | ||
necessarily traveled by
him within the State of Illinois in | ||
attending such hearing, not to
exceed a distance of 300 miles, | ||
to be taxed by the Commission as costs
and deposited with the |
petition of the employer.
| ||
When compensation which is payable in accordance with an | ||
award or
settlement contract approved by the Commission, is | ||
ordered paid in a
lump sum by the Commission, no review shall | ||
be had as in this paragraph
mentioned.
| ||
(i) Each party, upon taking any proceedings or steps | ||
whatsoever
before any Arbitrator, Commission or court, shall | ||
file with the Commission
his address, or the name and address | ||
of any agent upon whom all notices to
be given to such party | ||
shall be served, either personally or by registered
mail, | ||
addressed to such party or agent at the last address so filed | ||
with
the Commission. In the event such party has not filed his | ||
address, or the
name and address of an agent as above provided, | ||
service of any notice may
be had by filing such notice with the | ||
Commission.
| ||
(j) Whenever in any proceeding testimony has been taken or | ||
a final
decision has been rendered and after the taking of such | ||
testimony or
after such decision has become final, the injured | ||
employee dies, then in
any subsequent proceedings brought by | ||
the personal representative or
beneficiaries of the deceased | ||
employee, such testimony in the former
proceeding may be | ||
introduced with the same force and effect as though
the | ||
witness having so testified were present in person in such
| ||
subsequent proceedings and such final decision, if any, shall | ||
be taken
as final adjudication of any of the issues which are | ||
the same in both
proceedings.
|
(k) In case where there has been any unreasonable or | ||
vexatious delay
of payment or intentional underpayment of | ||
compensation, or proceedings
have been instituted or carried | ||
on by the one liable to pay the
compensation, which do not | ||
present a real controversy, but are merely
frivolous or for | ||
delay, then the Commission may award compensation
additional | ||
to that otherwise payable under this Act equal to 50% of the
| ||
amount payable at the time of such award. Failure to pay | ||
compensation
in accordance with the provisions of Section 8, | ||
paragraph (b) of this
Act, shall be considered unreasonable | ||
delay.
| ||
When determining whether this subsection (k) shall apply, | ||
the
Commission shall consider whether an Arbitrator has | ||
determined
that the claim is not compensable or whether the | ||
employer has
made payments under Section 8(j). | ||
(l) If the employee has made written demand for payment of
| ||
benefits under Section 8(a) or Section 8(b), the employer | ||
shall
have 14 days after receipt of the demand to set forth in
| ||
writing the reason for the delay. In the case of demand for
| ||
payment of medical benefits under Section 8(a), the time for
| ||
the employer to respond shall not commence until the | ||
expiration
of the allotted 30 days specified under Section | ||
8.2(d). In case
the employer or his or her insurance carrier | ||
shall without good and
just cause fail, neglect, refuse, or | ||
unreasonably delay the
payment of benefits under Section 8(a) | ||
or Section 8(b), the
Arbitrator or the Commission shall allow |
to the employee
additional compensation in the sum of $30 per | ||
day for each day
that the benefits under Section 8(a) or | ||
Section 8(b) have been
so withheld or refused, not to exceed | ||
$10,000.
A delay in payment of 14 days or more
shall create a | ||
rebuttable presumption of unreasonable delay.
| ||
(m) If the commission finds that an accidental injury was | ||
directly
and proximately caused by the employer's wilful | ||
violation of a health
and safety standard under the Health and | ||
Safety Act or the Occupational Safety and Health Act in force | ||
at the time of the
accident, the arbitrator or the Commission | ||
shall allow to the injured
employee or his dependents, as the | ||
case may be, additional compensation
equal to 25% of the | ||
amount which otherwise would be payable under the
provisions | ||
of this Act exclusive of this paragraph. The additional
| ||
compensation herein provided shall be allowed by an | ||
appropriate increase
in the applicable weekly compensation | ||
rate.
| ||
(n) After June 30, 1984, decisions of the Illinois | ||
Workers' Compensation Commission
reviewing an award of an | ||
arbitrator of the Commission shall draw interest
at a rate | ||
equal to the yield on indebtedness issued by the United States
| ||
Government with a 26-week maturity next previously auctioned | ||
on the day on
which the decision is filed. Said rate of | ||
interest shall be set forth in
the Arbitrator's Decision. | ||
Interest shall be drawn from the date of the
arbitrator's | ||
award on all accrued compensation due the employee through the
|
day prior to the date of payments. However, when an employee | ||
appeals an
award of an Arbitrator or the Commission, and the | ||
appeal results in no
change or a decrease in the award, | ||
interest shall not further accrue from
the date of such | ||
appeal.
| ||
The employer or his insurance carrier may tender the | ||
payments due under
the award to stop the further accrual of | ||
interest on such award
notwithstanding the prosecution by | ||
either party of review, certiorari,
appeal to the Supreme | ||
Court or other steps to reverse, vacate or modify
the award.
| ||
(o) By the 15th day of each month each insurer providing | ||
coverage for
losses under this Act shall notify each insured | ||
employer of any compensable
claim incurred during the | ||
preceding month and the amounts paid or reserved
on the claim | ||
including a summary of the claim and a brief statement of the
| ||
reasons for compensability. A cumulative report of all claims | ||
incurred
during a calendar year or continued from the previous | ||
year shall be
furnished to the insured employer by the insurer | ||
within 30 days after the
end of that calendar year.
| ||
The insured employer may challenge, in proceeding before | ||
the Commission,
payments made by the insurer without | ||
arbitration and payments
made after a case is determined to be | ||
noncompensable. If the Commission
finds that the case was not | ||
compensable, the insurer shall purge its records
as to that | ||
employer of any loss or expense associated with the claim, | ||
reimburse
the employer for attorneys' fees arising from the |
challenge and for any
payment required of the employer to the | ||
Rate Adjustment Fund or the
Second Injury Fund, and may not | ||
reflect the loss or expense for rate making
purposes. The | ||
employee shall not be required to refund the challenged
| ||
payment. The decision of the Commission may be reviewed in the | ||
same manner
as in arbitrated cases. No challenge may be | ||
initiated under this paragraph
more than 3 years after the | ||
payment is made. An employer may waive the
right of challenge | ||
under this paragraph on a case by case basis.
| ||
(p) After filing an application for adjustment of claim | ||
but prior to
the hearing on arbitration the parties may | ||
voluntarily agree to submit such
application for adjustment of | ||
claim for decision by an arbitrator under
this subsection (p) | ||
where such application for adjustment of claim raises
only a | ||
dispute over temporary total disability, permanent partial
| ||
disability or medical expenses. Such agreement shall be in | ||
writing in such
form as provided by the Commission. | ||
Applications for adjustment of claim
submitted for decision by | ||
an arbitrator under this subsection (p) shall
proceed | ||
according to rule as established by the Commission. The | ||
Commission
shall promulgate rules including, but not limited | ||
to, rules to ensure that
the parties are adequately informed | ||
of their rights under this subsection
(p) and of the voluntary | ||
nature of proceedings under this subsection (p).
The findings | ||
of fact made by an arbitrator acting within his or her powers
| ||
under this subsection (p) in the absence of fraud shall be |
conclusive.
However, the arbitrator may on his own motion, or | ||
the motion of either
party, correct any clerical errors or | ||
errors in computation within 15 days
after the date of receipt | ||
of such award of the arbitrator
and shall have the power to | ||
recall the original award on arbitration, and
issue in lieu | ||
thereof such corrected award.
The decision of the arbitrator | ||
under this subsection (p) shall be
considered the decision of | ||
the Commission and proceedings for review of
questions of law | ||
arising from the decision may be commenced by either party
| ||
pursuant to subsection (f) of Section 19. The Advisory Board | ||
established
under Section 13.1 shall compile a list of | ||
certified Commission
arbitrators, each of whom shall be | ||
approved by at least 7 members of the
Advisory Board. The | ||
chairman shall select 5 persons from such list to
serve as | ||
arbitrators under this subsection (p). By agreement, the | ||
parties
shall select one arbitrator from among the 5 persons | ||
selected by the
chairman except that if the parties do not | ||
agree on an arbitrator from
among the 5 persons, the parties | ||
may, by agreement, select an arbitrator of
the American | ||
Arbitration Association, whose fee shall be paid by the State
| ||
in accordance with rules promulgated by the Commission. | ||
Arbitration under
this subsection (p) shall be voluntary.
| ||
(Source: P.A. 101-384, eff. 1-1-20 .)
| ||
Section 45. The Workers' Occupational Diseases Act is | ||
amended by changing Section 19 as follows:
|
(820 ILCS 310/19) (from Ch. 48, par. 172.54)
| ||
Sec. 19. Any disputed questions of law or fact shall be | ||
determined as
herein provided.
| ||
(a) It shall be the duty of the Commission upon | ||
notification that
the parties have failed to reach an | ||
agreement to designate an
Arbitrator.
| ||
(1) The application for adjustment of claim filed with | ||
the
Commission shall state:
| ||
A. The approximate date of the last day of the last | ||
exposure and the
approximate date of the disablement.
| ||
B. The general nature and character of the illness | ||
or disease
claimed.
| ||
C. The name and address of the employer by whom | ||
employed on the last
day of the last exposure and if | ||
employed by any other employer after
such last | ||
exposure and before disablement the name and address | ||
of such
other employer or employers.
| ||
D. In case of death, the date and place of death.
| ||
(2) Amendments to applications for adjustment of claim | ||
which relate
to the same disablement or disablement | ||
resulting in death originally
claimed upon may be allowed | ||
by the Commissioner or an Arbitrator
thereof, in their | ||
discretion, and in the exercise of such discretion,
they | ||
may in proper cases order a trial de novo; such amendment | ||
shall
relate back to the date of the filing of the original |
application so
amended.
| ||
(3) Whenever any claimant misconceives his remedy and | ||
files an
application for adjustment of claim under this | ||
Act and it is
subsequently discovered, at any time before | ||
final disposition of such
cause, that the claim for | ||
disability or death which was the basis for
such | ||
application should properly have been made under the | ||
Workers'
Compensation Act, then the provisions of Section | ||
19 paragraph (a-1) of
the Workers' Compensation Act having | ||
reference to such application shall
apply.
| ||
Whenever any claimant misconceives his remedy and | ||
files an
application for adjustment of claim under the | ||
Workers' Compensation Act
and it is subsequently | ||
discovered, at any time before final disposition
of such | ||
cause that the claim for injury or death which was the | ||
basis for
such application should properly have been made | ||
under this Act, then the
application so filed under the | ||
Workers' Compensation Act may be amended
in form, | ||
substance or both to assert claim for such disability or | ||
death
under this Act and it shall be deemed to have been so | ||
filed as amended
on the date of the original filing | ||
thereof, and such compensation may be
awarded as is | ||
warranted by the whole evidence pursuant to the provisions
| ||
of this Act. When such amendment is submitted, further or | ||
additional
evidence may be heard by the Arbitrator or | ||
Commission when deemed
necessary; provided, that nothing |
in this Section contained shall be
construed to be or | ||
permit a waiver of any provisions of this Act with
| ||
reference to notice, but notice if given shall be deemed | ||
to be a notice
under the provisions of this Act if given | ||
within the time required
herein.
| ||
(b) The Arbitrator shall make such inquiries and | ||
investigations as he
shall deem necessary and may examine and | ||
inspect all books, papers,
records, places, or premises | ||
relating to the questions in dispute and hear
such proper | ||
evidence as the parties may submit.
| ||
The hearings before the Arbitrator shall be held in the | ||
vicinity where
the last exposure occurred, after 10 days' | ||
notice of the time and place of
such hearing shall have been | ||
given to each of the parties or their attorneys of record.
| ||
The Arbitrator may find that the disabling condition is | ||
temporary and has
not yet reached a permanent condition and | ||
may order the payment of
compensation up to the date of the | ||
hearing, which award shall be reviewable
and enforceable in | ||
the same manner as other awards, and in no instance be a
bar to | ||
a further hearing and determination of a further amount of | ||
temporary
total compensation or of compensation for permanent | ||
disability, but shall
be conclusive as to all other questions | ||
except the nature and extent of such
disability.
| ||
The decision of the Arbitrator shall be filed with the | ||
Commission which
Commission shall immediately send to each | ||
party or his attorney a copy of
such decision, together with a |
notification of the time when it was filed.
As of the effective | ||
date of this amendatory Act of the 94th General Assembly, all | ||
decisions of the Arbitrator shall set forth
in writing | ||
findings of fact and conclusions of law, separately stated, if | ||
requested by either party.
Unless a petition for review is | ||
filed by either party within 30 days after
the receipt by such | ||
party of the copy of the decision and notification of
time when | ||
filed, and unless such party petitioning for a review shall
| ||
within 35 days after the receipt by him of the copy of the | ||
decision, file
with the Commission either an agreed statement | ||
of the facts appearing upon
the hearing before the Arbitrator, | ||
or if such party shall so elect a
correct transcript of | ||
evidence of the proceedings at such hearings, then
the | ||
decision shall become the decision of the Commission and in | ||
the absence
of fraud shall be conclusive. The Petition for | ||
Review shall contain a
statement of the petitioning party's | ||
specific exceptions to the decision of
the arbitrator. The | ||
jurisdiction of the Commission to review the decision
of the | ||
arbitrator shall not be limited to the exceptions stated in | ||
the
Petition for Review. The Commission, or any member | ||
thereof, may grant
further time not exceeding 30 days, in | ||
which to file such agreed statement
or transcript of evidence. | ||
Such agreed statement of facts or correct
transcript of | ||
evidence, as the case may be, shall be authenticated by the
| ||
signatures of the parties or their attorneys, and in the event | ||
they do not
agree as to the correctness of the transcript of |
evidence it shall be
authenticated by the signature of the | ||
Arbitrator designated by the Commission.
| ||
Whether the employee is working or not, if the employee is | ||
not receiving or has not received medical, surgical, or | ||
hospital services or other services or compensation as | ||
provided in paragraph (a) of Section 8 of the Workers' | ||
Compensation
Act, or compensation as provided in paragraph (b) | ||
of Section 8 of the Workers' Compensation
Act, the employee | ||
may at any time petition for an expedited hearing by an | ||
Arbitrator on the issue of whether or not he or she is entitled | ||
to receive payment of the services or compensation. Provided | ||
the employer continues to pay compensation pursuant to | ||
paragraph (b) of Section 8 of the Workers' Compensation
Act, | ||
the employer may at any time petition for an expedited hearing | ||
on the issue of whether or not the employee is entitled to | ||
receive medical, surgical, or hospital services or other | ||
services or compensation as provided in paragraph (a) of | ||
Section 8 of the Workers' Compensation
Act, or compensation as | ||
provided in paragraph (b) of Section 8 of the Workers' | ||
Compensation
Act. When an employer has petitioned for an | ||
expedited hearing, the employer shall continue to pay | ||
compensation as provided in paragraph (b) of Section 8 of the | ||
Workers' Compensation
Act unless the arbitrator renders a | ||
decision that the employee is not entitled to the benefits | ||
that are the subject of the expedited hearing or unless the | ||
employee's treating physician has released the employee to |
return to work at his or her regular job with the employer or | ||
the employee actually returns to work at any other job. If the | ||
arbitrator renders a decision that the employee is not | ||
entitled to the benefits that are the subject of the expedited | ||
hearing, a petition for review filed by the employee shall | ||
receive the same priority as if the employee had filed a | ||
petition for an expedited hearing by an arbitrator. Neither | ||
party shall be entitled to an expedited hearing when the | ||
employee has returned to work and the sole issue in dispute | ||
amounts to less than 12 weeks of unpaid compensation pursuant | ||
to paragraph (b) of Section 8 of the Workers' Compensation
| ||
Act. | ||
Expedited hearings shall have priority over all other | ||
petitions and shall be heard by the Arbitrator and Commission | ||
with all convenient speed. Any party requesting an expedited | ||
hearing shall give notice of a request for an expedited | ||
hearing under this paragraph. A copy of the Application for | ||
Adjustment of Claim shall be attached to the notice. The | ||
Commission shall adopt rules and procedures under which the | ||
final decision of the Commission under this paragraph is filed | ||
not later than 180 days from the date that the Petition for | ||
Review is filed with the Commission. | ||
Where 2 or more insurance carriers, private self-insureds, | ||
or a group workers' compensation pool under Article V 3/4 of | ||
the Illinois Insurance Code dispute coverage for the same | ||
disease, any such insurance carrier, private self-insured, or |
group workers' compensation pool may request an expedited | ||
hearing pursuant to this paragraph to determine the issue of | ||
coverage, provided coverage is the only issue in dispute and | ||
all other issues are stipulated and agreed to and further | ||
provided that all compensation benefits including medical | ||
benefits pursuant to Section 8(a) of the Workers' Compensation
| ||
Act continue to be paid to or on behalf of petitioner. Any | ||
insurance carrier, private self-insured, or group workers' | ||
compensation pool that is determined to be liable for coverage | ||
for the disease in issue shall reimburse any insurance | ||
carrier, private self-insured, or group workers' compensation | ||
pool that has paid benefits to or on behalf of petitioner for | ||
the disease.
| ||
(b-1) If the employee is not receiving, pursuant to | ||
Section 7, medical,
surgical or hospital services of the type | ||
provided for in paragraph (a) of
Section 8 of the Workers' | ||
Compensation Act or compensation of the type
provided for in | ||
paragraph (b) of Section 8 of the Workers' Compensation
Act, | ||
the employee, in accordance with Commission Rules, may file a | ||
petition
for an emergency hearing by an Arbitrator on the | ||
issue of whether or not he
is entitled to receive payment of | ||
such compensation or services as provided
therein. Such | ||
petition shall have priority over all other petitions and
| ||
shall be heard by the Arbitrator and Commission with all | ||
convenient speed.
| ||
Such petition shall contain the following information and |
shall be served
on the employer at least 15 days before it is | ||
filed:
| ||
(i) the date and approximate time of the last | ||
exposure;
| ||
(ii) the approximate location of the last exposure;
| ||
(iii) a description of the last exposure;
| ||
(iv) the nature of the disability incurred by the | ||
employee;
| ||
(v) the identity of the person, if known, to whom the | ||
disability was
reported and the date on which it was | ||
reported;
| ||
(vi) the name and title of the person, if known, | ||
representing the
employer with whom the employee conferred | ||
in any effort to obtain pursuant
to Section 7 compensation | ||
of the type provided for in paragraph (b) of
Section 8 of | ||
the Workers' Compensation Act or medical, surgical or | ||
hospital
services of the type provided for in paragraph | ||
(a) of Section 8 of the
Workers' Compensation Act and the | ||
date of such conference;
| ||
(vii) a statement that the employer has refused to pay | ||
compensation
pursuant to Section 7 of the type provided | ||
for in paragraph (b) of Section
8 of the Workers' | ||
Compensation Act or for medical, surgical
or hospital | ||
services pursuant to Section 7 of the type provided for in
| ||
paragraph (a) of Section 8 of the Workers' Compensation | ||
Act;
|
(viii) the name and address, if known, of each witness | ||
to the last
exposure and of each other person upon whom the | ||
employee will rely to
support his allegations;
| ||
(ix) the dates of treatment related to the disability | ||
by medical
practitioners, and the names and addresses of | ||
such practitioners, including
the dates of treatment | ||
related to the disability at any hospitals and the
names | ||
and addresses of such hospitals, and a signed | ||
authorization
permitting the employer to examine all | ||
medical records of all practitioners
and hospitals named | ||
pursuant to this paragraph;
| ||
(x) a copy of a signed report by a medical | ||
practitioner, relating to the
employee's current inability | ||
to return to work because of the disability
incurred as a | ||
result of the exposure or such other documents or | ||
affidavits
which show that the employee is entitled to | ||
receive pursuant to Section 7
compensation of the type | ||
provided for in paragraph (b) of Section 8 of the
Workers' | ||
Compensation Act or medical, surgical or hospital services | ||
of the
type provided for in paragraph (a) of Section 8 of | ||
the Workers'
Compensation Act. Such reports, documents or | ||
affidavits shall state, if
possible, the history of the | ||
exposure given by the employee, and describe
the | ||
disability and medical diagnosis, the medical services for | ||
such
disability which the employee has received and is | ||
receiving, the physical
activities which the employee |
cannot currently perform as a result of such
disability, | ||
and the prognosis for recovery;
| ||
(xi) complete copies of any reports, records, | ||
documents and affidavits
in the possession of the employee | ||
on which the employee will rely to
support his | ||
allegations, provided that the employer shall pay the
| ||
reasonable cost of reproduction thereof;
| ||
(xii) a list of any reports, records, documents and | ||
affidavits which
the employee has demanded by subpoena and | ||
on which he intends to
rely to support his allegations;
| ||
(xiii) a certification signed by the employee or his | ||
representative that
the employer has received the petition | ||
with the required information 15
days before filing.
| ||
Fifteen days after receipt by the employer of the petition | ||
with the
required information the employee may file said | ||
petition and required
information and shall serve notice of | ||
the filing upon the employer. The
employer may file a motion | ||
addressed to the sufficiency of the petition.
If an objection | ||
has been filed to the sufficiency of the petition, the
| ||
arbitrator shall rule on the objection within 2 working days. | ||
If such an
objection is filed, the time for filing the final | ||
decision of the Commission
as provided in this paragraph shall | ||
be tolled until the arbitrator has
determined that the | ||
petition is sufficient.
| ||
The employer shall, within 15 days after receipt of the | ||
notice that such
petition is filed, file with the Commission |
and serve on the employee or
his representative a written | ||
response to each claim set
forth in the petition, including | ||
the legal and factual basis for each
disputed allegation and | ||
the following information: (i)
complete copies of any reports, | ||
records, documents and affidavits
in the possession of the | ||
employer on which the employer intends to rely in
support of | ||
his response, (ii) a list of any reports, records, documents | ||
and
affidavits which the employer has demanded by subpoena and | ||
on which the
employer intends to rely in support of his | ||
response, (iii) the name and address
of each witness on whom | ||
the employer will rely to support his response,
and (iv) the | ||
names and addresses of any medical practitioners
selected by | ||
the employer pursuant to Section 12 of this Act and the time
| ||
and place of any examination scheduled to be made pursuant to | ||
such Section.
| ||
Any employer who does not timely file and serve a written | ||
response
without good cause may not introduce any evidence to | ||
dispute any claim of
the employee but may cross examine the | ||
employee or any witness brought by
the employee and otherwise | ||
be heard.
| ||
No document or other evidence not previously identified by | ||
either party
with the petition or written response, or by any | ||
other means before the
hearing, may be introduced into | ||
evidence without good cause. If, at the
hearing, material | ||
information is discovered which was not previously
disclosed, | ||
the Arbitrator may extend the time for closing proof on the
|
motion of a party for a reasonable period of time which may be | ||
more than 30
days. No evidence may be introduced pursuant to | ||
this paragraph as to
permanent disability. No award may be | ||
entered for permanent disability
pursuant to this paragraph. | ||
Either party may introduce into evidence the
testimony taken | ||
by deposition of any medical practitioner.
| ||
The Commission shall adopt rules, regulations and | ||
procedures whereby
the final decision of the Commission is | ||
filed not later than 90 days from
the date the petition for | ||
review is filed but in no event later than 180
days from the | ||
date the petition for an emergency hearing is filed with the
| ||
Illinois Workers' Compensation Commission.
| ||
All service required pursuant to this paragraph (b-1) must | ||
be by personal
service or by certified mail and with evidence | ||
of receipt. In addition,
for the purposes of this paragraph, | ||
all service on the employer must be at
the premises where the | ||
accident occurred if the premises are owned or
operated by the | ||
employer. Otherwise service must be at the employee's
| ||
principal place of employment by the employer. If service on | ||
the employer
is not possible at either of the above, then | ||
service shall be at the
employer's principal place of | ||
business. After initial service in each case,
service shall be | ||
made on the employer's attorney or designated representative.
| ||
(c)(1) At a reasonable time in advance of and in | ||
connection with the
hearing under Section 19(e) or 19(h), the | ||
Commission may on its own motion
order an impartial physical |
or mental examination of a petitioner whose
mental or physical | ||
condition is in issue, when in the Commission's
discretion it | ||
appears that such an examination will materially aid in the
| ||
just determination of the case. The examination shall be made | ||
by a member
or members of a panel of physicians chosen for | ||
their special qualifications
by the Illinois State Medical | ||
Society. The Commission shall establish
procedures by which a | ||
physician shall be selected from such list.
| ||
(2) Should the Commission at any time during the hearing | ||
find that
compelling considerations make it advisable to have | ||
an examination and
report at that time, the Commission may in | ||
its discretion so order.
| ||
(3) A copy of the report of examination shall be given to | ||
the Commission
and to the attorneys for the parties.
| ||
(4) Either party or the Commission may call the examining | ||
physician
or physicians to testify. Any physician so called | ||
shall be subject to
cross-examination.
| ||
(5) The examination shall be made, and the physician or | ||
physicians,
if called, shall testify, without cost to the | ||
parties. The Commission shall
determine the compensation and | ||
the pay of the physician or physicians. The
compensation for | ||
this service shall not exceed the usual and customary amount
| ||
for such service.
| ||
The fees and payment thereof of all attorneys and | ||
physicians for
services authorized by the Commission under | ||
this Act shall, upon request
of either the employer or the |
employee or the beneficiary affected, be
subject to the review | ||
and decision of the Commission.
| ||
(d) If any employee shall persist in insanitary or | ||
injurious
practices which tend to either imperil or retard his | ||
recovery or shall
refuse to submit to such medical, surgical, | ||
or hospital treatment as is
reasonably essential to promote | ||
his recovery, the Commission may, in its
discretion, reduce or | ||
suspend the compensation of any such employee;
provided, that | ||
when an employer and employee so agree in writing, the
| ||
foregoing provision shall not be construed to authorize the | ||
reduction or
suspension of compensation of an employee who is | ||
relying in good faith,
on treatment by prayer or spiritual | ||
means alone, in accordance with the
tenets and practice of a | ||
recognized church or religious denomination, by
a duly | ||
accredited practitioner thereof.
| ||
(e) This paragraph shall apply to all hearings before the | ||
Commission.
Such hearings may be held in its office or | ||
elsewhere as the Commission may
deem advisable. The taking of | ||
testimony on such hearings may be had before
any member of the | ||
Commission. If a petition for review and agreed statement
of | ||
facts or transcript of evidence is filed, as provided herein, | ||
the
Commission shall promptly review the decision of the | ||
Arbitrator and all
questions of law or fact which appear from | ||
the statement of facts or
transcripts of evidence. In all | ||
cases in which the hearing before the
arbitrator is held after | ||
the effective date of this amendatory Act of 1989,
no |
additional evidence shall be introduced by the parties before | ||
the
Commission on review of the decision of the Arbitrator. | ||
The Commission
shall file in its office its decision thereon, | ||
and shall immediately send
to each party or his attorney a copy | ||
of such decision and a notification of
the time when it was | ||
filed. Decisions shall be filed within 60 days after
the | ||
Statement of Exceptions and Supporting Brief and Response | ||
thereto are
required to be filed or oral argument whichever is | ||
later.
| ||
In the event either party requests oral argument, such | ||
argument shall be
had before a panel of 3 members of the | ||
Commission (or before all available
members pursuant to the | ||
determination of 7 members of the Commission that
such | ||
argument be held before all available members of the | ||
Commission)
pursuant to the rules and regulations of the | ||
Commission. A panel of 3
members, which shall be comprised of | ||
not more than one representative
citizen of the employing | ||
class and not more than one representative from a labor | ||
organization recognized under the National Labor Relations Act | ||
or an attorney who has represented labor organizations or has | ||
represented employees in workers' compensation cases, shall | ||
hear the argument; provided that if all the
issues in dispute | ||
are solely the nature and extent of the permanent partial
| ||
disability, if any, a majority of the panel may deny the | ||
request for such
argument and such argument shall not be held; | ||
and provided further that 7
members of the Commission may |
determine that the argument be held before
all available | ||
members of the Commission. A decision of the Commission shall
| ||
be approved by a majority of Commissioners present at such | ||
hearing if any;
provided, if no such hearing is held, a | ||
decision of the Commission shall be
approved by a majority of a | ||
panel of 3 members of the Commission as
described in this | ||
Section. The Commission shall give 10 days' notice to the
| ||
parties or their attorneys of the time and place of such taking | ||
of
testimony and of such argument.
| ||
In any case the Commission in its decision may in its | ||
discretion find
specially upon any question or questions of | ||
law or facts which shall be
submitted in writing by either | ||
party whether ultimate or otherwise;
provided that on issues | ||
other than nature and extent of the disablement,
if any, the | ||
Commission in its decision shall find specially upon any
| ||
question or questions of law or fact, whether ultimate or | ||
otherwise,
which are submitted in writing by either party; | ||
provided further that
not more than 5 such questions may be | ||
submitted by either party. Any
party may, within 20 days after | ||
receipt of notice of the Commission's
decision, or within such | ||
further time, not exceeding 30 days, as the
Commission may | ||
grant, file with the Commission either an agreed
statement of | ||
the facts appearing upon the hearing, or, if such party
shall | ||
so elect, a correct transcript of evidence of the additional
| ||
proceedings presented before the Commission in which report | ||
the party
may embody a correct statement of such other |
proceedings in the case as
such party may desire to have | ||
reviewed, such statement of facts or
transcript of evidence to | ||
be authenticated by the signature of the
parties or their | ||
attorneys, and in the event that they do not agree,
then the | ||
authentication of such transcript of evidence shall be by the
| ||
signature of any member of the Commission.
| ||
If a reporter does not for any reason furnish a transcript | ||
of the
proceedings before the Arbitrator in any case for use on | ||
a hearing for
review before the Commission, within the | ||
limitations of time as fixed in
this Section, the Commission | ||
may, in its discretion, order a trial de
novo before the | ||
Commission in such case upon application of either
party. The | ||
applications for adjustment of claim and other documents in
| ||
the nature of pleadings filed by either party, together with | ||
the
decisions of the Arbitrator and of the Commission and the | ||
statement of
facts or transcript of evidence hereinbefore | ||
provided for in paragraphs
(b) and (c) shall be the record of | ||
the proceedings of the Commission,
and shall be subject to | ||
review as hereinafter provided.
| ||
At the request of either party or on its own motion, the | ||
Commission shall
set forth in writing the reasons for the | ||
decision, including findings of
fact and conclusions of law, | ||
separately stated. The Commission shall by
rule adopt a format | ||
for written decisions for the Commission and
arbitrators. The | ||
written decisions shall be concise and shall succinctly
state | ||
the facts and reasons for the decision. The Commission may |
adopt in
whole or in part, the decision of the arbitrator as | ||
the decision of the
Commission. When the Commission does so | ||
adopt the decision of the
arbitrator, it shall do so by order. | ||
Whenever the Commission adopts part of
the arbitrator's | ||
decision, but not all, it shall include in the order the
| ||
reasons for not adopting all of the arbitrator's decision. | ||
When a majority
of a panel, after deliberation, has arrived at | ||
its decision, the decision
shall be filed as provided in this | ||
Section without unnecessary delay, and
without regard to the | ||
fact that a member of the panel has expressed an
intention to | ||
dissent. Any member of the panel may file a dissent. Any
| ||
dissent shall be filed no later than 10 days after the decision | ||
of the
majority has been filed.
| ||
Decisions rendered by the Commission after the effective | ||
date of this
amendatory Act of 1980 and dissents, if any, shall | ||
be published
together by the Commission. The conclusions
of | ||
law set out in such decisions shall be regarded as precedents
| ||
by arbitrators, for the purpose of achieving
a more uniform | ||
administration of this Act.
| ||
(f) The decision of the Commission acting within its | ||
powers,
according to the provisions of paragraph (e) of this | ||
Section shall, in
the absence of fraud, be conclusive unless | ||
reviewed as in this paragraph
hereinafter provided. However, | ||
the Arbitrator or the Commission may on
his or its own motion, | ||
or on the motion of either party, correct any
clerical error or | ||
errors in computation within 15 days after the date of
receipt |
of any award by such Arbitrator or any decision on review of | ||
the
Commission, and shall have the power to recall the | ||
original award on
arbitration or decision on review, and issue | ||
in lieu thereof such
corrected award or decision. Where such | ||
correction is made the time for
review herein specified shall | ||
begin to run from the date of
the receipt of the corrected | ||
award or decision.
| ||
(1) Except in cases of claims against the State of | ||
Illinois, in
which case the decision of the Commission | ||
shall not be subject to
judicial review, the Circuit Court | ||
of the county where any of the
parties defendant may be | ||
found, or if none of the parties defendant be
found in this | ||
State then the Circuit Court of the county where any of
the | ||
exposure occurred, shall by summons to the Commission
have | ||
power to review all questions of law and fact presented by | ||
such
record.
| ||
A proceeding for review shall be commenced within 20 | ||
days of the
receipt of notice of the decision of the | ||
Commission. The summons shall be
issued by the clerk of | ||
such court upon written request returnable on a
designated | ||
return day, not less than 10 or more than 60 days from the | ||
date
of issuance thereof, and the written request shall | ||
contain the last known
address of other parties in | ||
interest and their attorneys of record who are
to be | ||
served by summons. Service upon any member of the | ||
Commission or the
Secretary or the Assistant Secretary |
thereof shall be service upon the
Commission, and service | ||
upon other parties in interest and their attorneys
of | ||
record shall be by summons, and such service shall be made | ||
upon the
Commission and other parties in interest by | ||
mailing notices of the
commencement of the proceedings and | ||
the return day of the summons to the
office of the | ||
Commission and to the last known place of residence of
| ||
other parties in interest or their attorney or attorneys | ||
of record. The
clerk of the court issuing the summons | ||
shall on the day of issue mail notice
of the commencement | ||
of the proceedings which shall be done by mailing a
copy of | ||
the summons to the office of the Commission, and a copy of | ||
the
summons to the other parties in interest or their | ||
attorney or
attorneys of record and the clerk of the court | ||
shall make certificate
that he has so sent such notices in | ||
pursuance of this Section, which
shall be evidence of | ||
service on the Commission and other parties in
interest.
| ||
The Commission shall not be required to certify the | ||
record of their
proceedings in the Circuit Court unless | ||
the party commencing the
proceedings for review in the | ||
Circuit Court as above provided, shall file with the | ||
Commission notice of intent to file for review in Circuit | ||
Court. It shall be
the duty of the Commission upon such | ||
filing of notice of intent to file for review in Circuit | ||
Court to prepare a true and correct
copy of such testimony | ||
and a true and correct copy of all
other matters contained |
in such record and certified to by the Secretary
or | ||
Assistant Secretary thereof. The changes made to this | ||
subdivision (f)(1) by this amendatory Act of the 98th | ||
General Assembly apply to any Commission decision entered | ||
after the effective date of this amendatory Act of the | ||
98th General Assembly.
| ||
No request
for a summons may be filed and no summons | ||
shall
issue unless the party seeking to review the | ||
decision of the Commission
shall exhibit to the clerk of | ||
the Circuit Court proof of
filing with the Commission of | ||
the notice of the intent to file for review in the Circuit | ||
Court or an affidavit of the attorney setting
forth that | ||
notice of intent to file for review in Circuit Court has | ||
been given in writing to the Secretary
or Assistant | ||
Secretary of the Commission.
| ||
(2) No such summons shall issue unless the one against
| ||
whom the Commission shall have rendered an award for the | ||
payment of money
shall upon the filing of his written | ||
request for such summons file with the
clerk of the court a | ||
bond conditioned that if he shall not successfully
| ||
prosecute the review, he will pay the award and the costs | ||
of the
proceedings in the court. The amount of the bond | ||
shall be fixed by any
member of the Commission and the | ||
surety or sureties of the bond shall be
approved by the | ||
clerk of the court. The acceptance of the bond by the
clerk | ||
of the court shall constitute evidence of his approval of |
the
bond.
| ||
The following Every county, city, town, township, | ||
incorporated village, school
district, body politic or | ||
municipal corporation having a population of
500,000 or | ||
more against whom the Commission shall have rendered an | ||
award
for the payment of money shall not be required to | ||
file a bond to secure
the payment of the award and the | ||
costs of the proceedings in the court
to authorize the | ||
court to issue such summons : .
| ||
(1) the State Treasurer, for a fund administered | ||
by the State Treasurer ex officio against whom the | ||
Commission shall have rendered an award for the | ||
payment of money; and | ||
(2) a county, city, town, township, incorporated | ||
village, school district, body politic, or municipal | ||
corporation having a population of 500,000 or more | ||
against whom the Commission shall have rendered an | ||
award for the payment of money. | ||
The court may confirm or set aside the decision of the | ||
Commission. If
the decision is set aside and the facts | ||
found in the proceedings before
the Commission are | ||
sufficient, the court may enter such decision as is
| ||
justified by law, or may remand the cause to the | ||
Commission for further
proceedings and may state the | ||
questions requiring further hearing, and
give such other | ||
instructions as may be proper. Appeals shall be taken
to |
the Appellate Court in accordance
with Supreme Court Rules | ||
22(g) and 303. Appeals shall be taken from the
Appellate | ||
Court to the Supreme Court
in accordance with Supreme | ||
Court Rule 315.
| ||
It shall be the duty of the clerk of any court | ||
rendering a decision
affecting or affirming an award of | ||
the Commission to promptly furnish
the Commission with a | ||
copy of such decision, without charge.
| ||
The decision of a majority of the members of the panel | ||
of the Commission,
shall be considered the decision of the | ||
Commission.
| ||
(g) Except in the case of a claim against the State of | ||
Illinois,
either party may present a certified copy of the | ||
award of the
Arbitrator, or a certified copy of the decision of | ||
the Commission when
the same has become final, when no | ||
proceedings for review are pending,
providing for the payment | ||
of compensation according to this Act, to the
Circuit Court of | ||
the county in which such exposure occurred or either of
the | ||
parties are residents, whereupon the court shall enter a | ||
judgment
in accordance therewith. In case where the employer | ||
refuses to pay
compensation according to such final award or | ||
such final decision upon
which such judgment is entered, the | ||
court shall in entering judgment
thereon, tax as costs against | ||
him the reasonable costs and attorney fees
in the arbitration | ||
proceedings and in the court entering the judgment
for the | ||
person in whose favor the judgment is entered, which judgment
|
and costs taxed as herein provided shall, until and unless set | ||
aside,
have the same effect as though duly entered in an action | ||
duly tried and
determined by the court, and shall with like | ||
effect, be entered and
docketed. The Circuit Court shall have | ||
power at any time upon
application to make any such judgment | ||
conform to any modification
required by any subsequent | ||
decision of the Supreme Court upon appeal, or
as the result of | ||
any subsequent proceedings for review, as provided in
this | ||
Act.
| ||
Judgment shall not be entered until 15 days' notice of the | ||
time and
place of the application for the entry of judgment | ||
shall be served upon
the employer by filing such notice with | ||
the Commission, which Commission
shall, in case it has on file | ||
the address of the employer or the name
and address of its | ||
agent upon whom notices may be served, immediately
send a copy | ||
of the notice to the employer or such designated agent.
| ||
(h) An agreement or award under this Act providing for | ||
compensation
in installments, may at any time within 18 months | ||
after such agreement
or award be reviewed by the Commission at | ||
the request of either the
employer or the employee on the | ||
ground that the disability of the
employee has subsequently | ||
recurred, increased, diminished or ended.
| ||
However, as to disablements occurring subsequently to July | ||
1, 1955,
which are covered by any agreement or award under this | ||
Act providing for
compensation in installments made as a | ||
result of such disablement, such
agreement or award may at any |
time within 30 months after such agreement
or award be | ||
reviewed by the Commission at the request of either the
| ||
employer or the employee on the ground that the disability of | ||
the
employee has subsequently recurred, increased, diminished | ||
or ended.
| ||
On such review compensation payments may be | ||
re-established,
increased, diminished or ended. The Commission | ||
shall give 15 days'
notice to the parties of the hearing for | ||
review. Any employee, upon any
petition for such review being | ||
filed by the employer, shall be entitled
to one day's notice | ||
for each 100 miles necessary to be traveled by him in
attending | ||
the hearing of the Commission upon the petition, and 3 days in
| ||
addition thereto. Such employee shall, at the discretion of | ||
the
Commission, also be entitled to 5 cents per mile | ||
necessarily traveled by
him within the State of Illinois in | ||
attending such hearing, not to
exceed a distance of 300 miles, | ||
to be taxed by the Commission as costs
and deposited with the | ||
petition of the employer.
| ||
When compensation which is payable in accordance with an | ||
award or
settlement contract approved by the Commission, is | ||
ordered paid in a
lump sum by the Commission, no review shall | ||
be had as in this paragraph
mentioned.
| ||
(i) Each party, upon taking any proceedings or steps | ||
whatsoever
before any Arbitrator, Commission or court,
shall | ||
file with the Commission his address, or the name and address | ||
of
any agent upon whom all notices to be given to such party |
shall be
served, either personally or by registered mail, | ||
addressed to such party
or agent at the last address so filed | ||
with the Commission. In the event
such party has not filed his | ||
address, or the name and address of an
agent as above provided, | ||
service of any notice may be had by filing such
notice with the | ||
Commission.
| ||
(j) Whenever in any proceeding testimony has been taken or | ||
a final
decision has been rendered, and after the taking of | ||
such testimony or
after such decision has become final, the | ||
employee dies, then in any
subsequent proceeding brought by | ||
the personal representative or
beneficiaries of the deceased | ||
employee, such testimony in the former
proceeding may be | ||
introduced with the same force and effect as though
the | ||
witness having so testified were present in person in such
| ||
subsequent proceedings and such final decision, if any, shall | ||
be taken
as final adjudication of any of the issues which are | ||
the same in both
proceedings.
| ||
(k) In any case where there has been any unreasonable or | ||
vexatious
delay of payment or intentional underpayment of | ||
compensation, or
proceedings have been instituted or carried | ||
on by one liable to pay the
compensation, which do not present | ||
a real controversy, but are merely
frivolous or for delay, | ||
then the Commission may award compensation
additional to that | ||
otherwise payable under this Act equal to 50% of the
amount | ||
payable at the time of such award. Failure to pay compensation | ||
in
accordance with the provisions of Section 8, paragraph (b) |
of this Act,
shall be considered unreasonable delay.
| ||
When determining whether this subsection (k) shall apply, | ||
the
Commission shall consider whether an arbitrator has | ||
determined
that the claim is not compensable or whether the | ||
employer has
made payments under Section 8(j) of the Workers' | ||
Compensation Act. | ||
(k-1) If the employee has made written demand for payment | ||
of
benefits under Section 8(a) or Section 8(b) of the Workers' | ||
Compensation Act, the employer shall
have 14 days after | ||
receipt of the demand to set forth in
writing the reason for | ||
the delay. In the case of demand for
payment of medical | ||
benefits under Section 8(a) of the Workers' Compensation Act, | ||
the time for
the employer to respond shall not commence until | ||
the expiration
of the allotted 60 days specified under Section | ||
8.2(d) of the Workers' Compensation Act. In case
the employer | ||
or his or her insurance carrier shall without good and
just | ||
cause fail, neglect, refuse, or unreasonably delay the
payment | ||
of benefits under Section 8(a) or Section 8(b) of the Workers' | ||
Compensation Act, the
Arbitrator or the Commission shall allow | ||
to the employee
additional compensation in the sum of $30 per | ||
day for each day
that the benefits under Section 8(a) or | ||
Section 8(b) of the Workers' Compensation Act have been
so | ||
withheld or refused, not to exceed $10,000.
A delay in payment | ||
of 14 days or more
shall create a rebuttable presumption of | ||
unreasonable delay.
| ||
(l) By the 15th day of each month each insurer providing |
coverage for
losses under this Act shall notify each insured | ||
employer of any compensable
claim incurred during the | ||
preceding month and the amounts paid or reserved
on the claim | ||
including a summary of the claim and a brief statement of the
| ||
reasons for compensability. A cumulative report of all claims | ||
incurred
during a calendar year or continued
from the previous | ||
year shall be furnished to the insured employer by the
insurer | ||
within 30 days after the end of that calendar year.
| ||
The insured employer may challenge, in proceeding before | ||
the Commission,
payments made by the insurer without | ||
arbitration and payments made after
a case is determined to be | ||
noncompensable. If the Commission finds that
the case was not | ||
compensable, the insurer shall purge its records as to
that | ||
employer of any loss or expense associated with the claim, | ||
reimburse
the employer for attorneys fee arising from the | ||
challenge and for any payment
required of the employer to the | ||
Rate Adjustment Fund or the Second Injury
Fund, and may not | ||
effect the loss or expense for rate making purposes. The
| ||
employee shall not be required to refund the challenged | ||
payment. The
decision of the Commission may be reviewed in the | ||
same
manner as in arbitrated cases. No challenge may be | ||
initiated under this
paragraph more than 3 years after the | ||
payment is made. An employer may
waive the right of challenge | ||
under this paragraph on a case by case basis.
| ||
(m) After filing an application for adjustment of claim | ||
but prior to
the hearing on arbitration the parties may |
voluntarily agree to submit such
application for adjustment of | ||
claim for decision by an arbitrator under
this subsection (m) | ||
where such application for adjustment
of claim raises only a | ||
dispute over temporary total disability, permanent
partial | ||
disability or medical expenses. Such agreement shall be in | ||
writing
in such form as provided by the Commission. | ||
Applications for adjustment of
claim submitted for decision by | ||
an arbitrator under
this subsection (m) shall proceed | ||
according
to rule as established by the Commission. The | ||
Commission shall promulgate
rules including, but not limited | ||
to, rules to ensure that the parties are
adequately informed | ||
of their rights under this subsection (m) and of the
voluntary | ||
nature of proceedings under this subsection
(m). The findings | ||
of fact made by an arbitrator acting within his or her
powers | ||
under this subsection (m) in the absence of fraud shall be
| ||
conclusive. However, the arbitrator may on his own motion, or | ||
the motion
of either party, correct any clerical errors or | ||
errors in computation
within 15 days after the date of receipt | ||
of such award of the arbitrator
and shall have the power to | ||
recall the original award on arbitration, and
issue in lieu | ||
thereof such corrected award.
The decision of the arbitrator | ||
under this subsection (m) shall be
considered the decision of | ||
the Commission and proceedings for review of
questions of law | ||
arising from the decision may be commenced by either party
| ||
pursuant to subsection (f) of Section 19. The Advisory Board | ||
established
under Section 13.1 of the Workers' Compensation |
Act shall compile a list of
certified Commission arbitrators, | ||
each of whom shall be approved by at least
7 members of the | ||
Advisory Board. The chairman shall select 5 persons
from such | ||
list to serve as arbitrators under this subsection (m). By
| ||
agreement, the parties shall select one arbitrator from among | ||
the 5 persons
selected by the chairman except, that if the | ||
parties do not agree on an
arbitrator from among the 5 persons, | ||
the parties may, by agreement,
select an arbitrator of the | ||
American Arbitration Association, whose fee
shall be paid by | ||
the State in accordance with rules promulgated by the
| ||
Commission. Arbitration under this subsection (m) shall be | ||
voluntary.
| ||
(Source: P.A. 101-384, eff. 1-1-20 .)
| ||
Section 50. The Unemployment Insurance Act is amended by
| ||
changing Section 1900 as follows:
| ||
(820 ILCS 405/1900) (from Ch. 48, par. 640)
| ||
Sec. 1900. Disclosure of information.
| ||
A. Except as provided in this Section, information | ||
obtained from any
individual or employing unit during the | ||
administration of this Act shall:
| ||
1. be confidential,
| ||
2. not be published or open to public inspection,
| ||
3. not be used in any court in any pending action or | ||
proceeding,
|
4. not be admissible in evidence in any action or | ||
proceeding other than
one arising out of this Act.
| ||
B. No finding, determination, decision, ruling , or order | ||
(including
any finding of fact, statement or conclusion made | ||
therein) issued pursuant
to this Act shall be admissible or | ||
used in evidence in any action other than
one arising out of | ||
this Act, nor shall it be binding or conclusive except
as | ||
provided in this Act, nor shall it constitute res judicata, | ||
regardless
of whether the actions were between the same or | ||
related parties or involved
the same facts.
| ||
C. Any officer or employee of this State, any officer or | ||
employee of any
entity authorized to obtain information | ||
pursuant to this Section, and any
agent of this State or of | ||
such entity
who, except with authority of
the Director under | ||
this Section or as authorized pursuant to subsection P-1, | ||
shall disclose information shall be guilty
of a Class B | ||
misdemeanor and shall be disqualified from holding any
| ||
appointment or employment by the State.
| ||
D. An individual or his duly authorized agent may be | ||
supplied with
information from records only to the extent | ||
necessary for the proper
presentation of his claim for | ||
benefits or with his existing or prospective
rights to | ||
benefits. Discretion to disclose this information belongs
| ||
solely to the Director and is not subject to a release or | ||
waiver by the
individual.
Notwithstanding any other provision | ||
to the contrary, an individual or his or
her duly authorized |
agent may be supplied with a statement of the amount of
| ||
benefits paid to the individual during the 18 months preceding | ||
the date of his
or her request.
| ||
E. An employing unit may be furnished with information, | ||
only if deemed by
the Director as necessary to enable it to | ||
fully discharge its obligations or
safeguard its rights under | ||
the Act. Discretion to disclose this information
belongs | ||
solely to the Director and is not subject to a release or | ||
waiver by the
employing unit.
| ||
F. The Director may furnish any information that he may | ||
deem proper to
any public officer or public agency of this or | ||
any other State or of the
federal government dealing with:
| ||
1. the administration of relief,
| ||
2. public assistance,
| ||
3. unemployment compensation,
| ||
4. a system of public employment offices,
| ||
5. wages and hours of employment, or
| ||
6. a public works program.
| ||
The Director may make available to the Illinois Workers' | ||
Compensation Commission or the Department of Insurance
| ||
information regarding employers for the purpose of verifying | ||
the insurance
coverage required under the Workers' | ||
Compensation Act and Workers'
Occupational Diseases Act.
| ||
G. The Director may disclose information submitted by the | ||
State or any
of its political subdivisions, municipal | ||
corporations, instrumentalities,
or school or community |
college districts, except for information which
specifically | ||
identifies an individual claimant.
| ||
H. The Director shall disclose only that information | ||
required to be
disclosed under Section 303 of the Social | ||
Security Act, as amended, including:
| ||
1. any information required to be given the United | ||
States Department of
Labor under Section 303(a)(6); and
| ||
2. the making available upon request to any agency of | ||
the United States
charged with the administration of | ||
public works or assistance through
public employment, the | ||
name, address, ordinary occupation , and employment
status | ||
of each recipient of unemployment compensation, and a | ||
statement of
such recipient's right to further | ||
compensation under such law as required
by Section | ||
303(a)(7); and
| ||
3. records to make available to the Railroad | ||
Retirement Board as
required by Section 303(c)(1); and
| ||
4. information that will assure reasonable cooperation | ||
with every agency
of the United States charged with the | ||
administration of any unemployment
compensation law as | ||
required by Section 303(c)(2); and
| ||
5. information upon request and on a reimbursable | ||
basis to the United
States Department of Agriculture and | ||
to any State food stamp agency
concerning any information | ||
required to be furnished by Section 303(d); and
| ||
6. any wage information upon request and on a |
reimbursable basis
to any State or local child support | ||
enforcement agency required by
Section 303(e); and
| ||
7. any information required under the income | ||
eligibility and
verification system as required by Section | ||
303(f); and
| ||
8. information that might be useful in locating an | ||
absent parent or that
parent's employer, establishing | ||
paternity or establishing, modifying, or
enforcing child | ||
support orders
for the purpose of a child support | ||
enforcement program
under Title IV of the Social Security | ||
Act upon the request of
and on a reimbursable basis to
the | ||
public
agency administering the Federal Parent Locator | ||
Service as required by
Section 303(h); and
| ||
9. information, upon request, to representatives of | ||
any federal, State ,
or local governmental public housing | ||
agency with respect to individuals who
have signed the | ||
appropriate consent form approved by the Secretary of | ||
Housing
and Urban Development and who are applying for or | ||
participating in any housing
assistance program | ||
administered by the United States Department of Housing | ||
and
Urban Development as required by Section 303(i).
| ||
I. The Director, upon the request of a public agency of | ||
Illinois, of the
federal government , or of any other state | ||
charged with the investigation or
enforcement of Section 10-5 | ||
of the Criminal Code of 2012 (or a similar
federal law or | ||
similar law of another State), may furnish the public agency
|
information regarding the individual specified in the request | ||
as to:
| ||
1. the current or most recent home address of the | ||
individual, and
| ||
2. the names and addresses of the individual's | ||
employers.
| ||
J. Nothing in this Section shall be deemed to interfere | ||
with the
disclosure of certain records as provided for in | ||
Section 1706 or with the
right to make available to the | ||
Internal Revenue Service of the United
States Department of | ||
the Treasury, or the Department of Revenue of the
State of | ||
Illinois, information obtained under this Act. With respect to | ||
each benefit claim that appears to have been filed other than | ||
by the individual in whose name the claim was filed or by the | ||
individual's authorized agent and with respect to which | ||
benefits were paid during the prior calendar year, the | ||
Director shall annually report to the Department of Revenue | ||
information that is in the Director's possession and may | ||
assist in avoiding negative income tax consequences for the | ||
individual in whose name the claim was filed.
| ||
K. The Department shall make available to the Illinois | ||
Student Assistance
Commission, upon request, information in | ||
the possession of the Department that
may be necessary or | ||
useful to the
Commission in the collection of defaulted or | ||
delinquent student loans which
the Commission administers.
| ||
L. The Department shall make available to the State |
Employees'
Retirement System, the State Universities | ||
Retirement System, the
Teachers' Retirement System of the | ||
State of Illinois, and the Department of Central Management | ||
Services, Risk Management Division, upon request,
information | ||
in the possession of the Department that may be necessary or | ||
useful
to the System or the Risk Management Division for the | ||
purpose of determining whether any recipient of a
disability | ||
benefit from the System or a workers' compensation benefit | ||
from the Risk Management Division is gainfully employed.
| ||
M. This Section shall be applicable to the information | ||
obtained in the
administration of the State employment | ||
service, except that the Director
may publish or release | ||
general labor market information and may furnish
information | ||
that he may deem proper to an individual, public officer , or
| ||
public agency of this or any other State or the federal | ||
government (in
addition to those public officers or public | ||
agencies specified in this
Section) as he prescribes by Rule.
| ||
N. The Director may require such safeguards as he deems | ||
proper to insure
that information disclosed pursuant to this | ||
Section is used only for the
purposes set forth in this | ||
Section.
| ||
O. Nothing in this Section prohibits communication with an | ||
individual or entity through unencrypted e-mail or other | ||
unencrypted electronic means as long as the communication does | ||
not contain the individual's or entity's name in combination | ||
with any one or more of the individual's or entity's entire or |
partial social security number; driver's license or State | ||
identification number; credit or debit card number; or any | ||
required security code, access code, or password that would | ||
permit access to further information pertaining to the | ||
individual or entity.
| ||
P. (Blank). | ||
P-1. With the express written consent of a claimant or
| ||
employing unit and an agreement not to publicly disclose, the | ||
Director shall provide requested information related to a | ||
claim
to an elected official performing constituent services | ||
or his or her agent.
| ||
Q. The Director shall make available to an elected federal
| ||
official the name and address of an individual or entity that | ||
is located within
the jurisdiction from which the official was | ||
elected and that, for the most
recently completed calendar | ||
year, has reported to the Department as paying
wages to | ||
workers, where the information will be used in connection with | ||
the
official duties of the official and the official requests | ||
the information in
writing, specifying the purposes for which | ||
it will be used.
For purposes of this subsection, the use of | ||
information in connection with the
official duties of an | ||
official does not include use of the information in
connection | ||
with the solicitation of contributions or expenditures, in | ||
money or
in kind, to or on behalf of a candidate for public or | ||
political office or a
political party or with respect to a | ||
public question, as defined in Section 1-3
of the Election |
Code, or in connection with any commercial solicitation. Any
| ||
elected federal official who, in submitting a request for | ||
information
covered by this subsection, knowingly makes a | ||
false statement or fails to
disclose a material fact, with the | ||
intent to obtain the information for a
purpose not authorized | ||
by this subsection, shall be guilty of a Class B
misdemeanor.
| ||
R. The Director may provide to any State or local child | ||
support
agency, upon request and on a reimbursable basis, | ||
information that might be
useful in locating an absent parent | ||
or that parent's employer, establishing
paternity, or | ||
establishing, modifying, or enforcing child support orders.
| ||
S. The Department shall make available to a State's | ||
Attorney of this
State or a State's Attorney's investigator,
| ||
upon request, the current address or, if the current address | ||
is
unavailable, current employer information, if available, of | ||
a victim of
a felony or a
witness to a felony or a person | ||
against whom an arrest warrant is
outstanding.
| ||
T. The Director shall make available to the Illinois State | ||
Police, a county sheriff's office, or a municipal police | ||
department, upon request, any information concerning the | ||
current address and place of employment or former places of | ||
employment of a person who is required to register as a sex | ||
offender under the Sex Offender Registration Act that may be | ||
useful in enforcing the registration provisions of that Act. | ||
U. The Director shall make information available to the | ||
Department of Healthcare and Family Services and the |
Department of Human Services for the purpose of determining | ||
eligibility for public benefit programs authorized under the | ||
Illinois Public Aid Code and related statutes administered by | ||
those departments, for verifying sources and amounts of | ||
income, and for other purposes directly connected with the | ||
administration of those programs. | ||
V. The Director shall make information available to the | ||
State Board of Elections as may be required by an agreement the | ||
State Board of Elections has entered into with a multi-state | ||
voter registration list maintenance system. | ||
W. The Director shall make information available to the | ||
State Treasurer's office and the Department of Revenue for the | ||
purpose of facilitating compliance with the Illinois Secure | ||
Choice Savings Program Act, including employer contact | ||
information for employers with 25 or more employees and any | ||
other information the Director deems appropriate that is | ||
directly related to the administration of this program. | ||
X. The Director shall make information available, upon | ||
request, to the Illinois Student Assistance Commission for the | ||
purpose of determining eligibility for the adult vocational | ||
community college scholarship program under Section 65.105 of | ||
the Higher Education Student Assistance Act. | ||
Y. Except as required under State or federal law, or | ||
unless otherwise provided for in this Section, the Department | ||
shall not disclose an individual's entire social security | ||
number in any correspondence physically mailed to an |
individual or entity. | ||
(Source: P.A. 101-315, eff. 1-1-20; 102-26, eff. 6-25-21; | ||
102-538, eff. 8-20-21; revised 11-8-21.)
| ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law.
|