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Public Act 094-0277 |
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AN ACT concerning employment.
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Be it enacted by the People of the State of Illinois, | ||||
represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by | ||||
changing Section 1204 as follows:
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(215 ILCS 5/1204) (from Ch. 73, par. 1065.904)
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Sec. 1204. (A) The Director shall promulgate rules and | ||||
regulations
which shall require each insurer licensed to write | ||||
property or casualty
insurance in the State and each syndicate | ||||
doing business on the Illinois
Insurance Exchange to record and | ||||
report its loss and expense experience
and other data as may be | ||||
necessary to assess the relationship of
insurance premiums and | ||||
related income as compared to insurance costs and
expenses. The | ||||
Director may designate one or more rate service
organizations | ||||
or advisory organizations to gather and compile such
experience | ||||
and data. The Director shall require each insurer licensed to
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write property or casualty insurance in this State and each | ||||
syndicate doing
business on the Illinois Insurance Exchange to | ||||
submit a report, on
a form furnished by the Director, showing | ||||
its direct writings in this
State and companywide.
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(B) Such report required by subsection (A) of this Section | ||||
may include,
but not be limited to, the following specific | ||||
types of insurance written by
such insurer:
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(1) Political subdivision liability insurance reported | ||||
separately in the
following categories:
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(a) municipalities;
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(b) school districts;
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(c) other political subdivisions;
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(2) Public official liability insurance;
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(3) Dram shop liability insurance;
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(4) Day care center liability insurance;
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(5) Labor, fraternal or religious organizations |
liability insurance;
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(6) Errors and omissions liability insurance;
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(7) Officers and directors liability insurance | ||
reported separately as
follows:
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(a) non-profit entities;
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(b) for-profit entities;
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(8) Products liability insurance;
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(9) Medical malpractice insurance;
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(10) Attorney malpractice insurance;
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(11) Architects and engineers malpractice insurance; | ||
and
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(12) Motor vehicle insurance reported separately for | ||
commercial and
private passenger vehicles as follows:
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(a) motor vehicle physical damage insurance;
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(b) motor vehicle liability insurance.
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(C) Such report may include, but need not be limited to the | ||
following data,
both
specific to this State and companywide, in | ||
the aggregate or by type of
insurance for the previous year on | ||
a calendar year basis:
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(1) Direct premiums written;
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(2) Direct premiums earned;
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(3) Number of policies;
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(4) Net investment income, using appropriate estimates | ||
where necessary;
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(5) Losses paid;
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(6) Losses incurred;
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(7) Loss reserves:
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(a) Losses unpaid on reported claims;
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(b) Losses unpaid on incurred but not reported | ||
claims;
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(8) Number of claims:
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(a) Paid claims;
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(b) Arising claims;
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(9) Loss adjustment expenses:
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(a) Allocated loss adjustment expenses;
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(b) Unallocated loss adjustment expenses;
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(10) Net underwriting gain or loss;
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(11) Net operation gain or loss, including net | ||
investment income;
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(12) Any other information requested by the Director.
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(C-5) Additional information by an advisory organization | ||
as defined in Section 463 of this Code. | ||
(1) An advisory organization as defined in Section 463 | ||
of this Code shall report annually the following | ||
information in such format as may be prescribed by the | ||
Secretary: | ||
(a) paid and incurred losses for each of the past | ||
10 years; | ||
(b) medical payments and medical charges, if | ||
collected, for each of the past 10 years; | ||
(c) the following indemnity payment information:
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cumulative payments by accident year by calendar year | ||
of
development. This array will show payments made and | ||
frequency of claims in the following categories: | ||
medical only, permanent partial disability (PPD), | ||
permanent total
disability (PTD), temporary total | ||
disability (TTD), and fatalities; | ||
(d) injuries by frequency and severity; | ||
(e) by class of employee. | ||
(2) The report filed with the Secretary of Financial | ||
and Professional Regulation under paragraph (1) of this
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subsection (C-5) shall be made available, on an aggregate | ||
basis, to the General
Assembly and to the general public. | ||
The identity of the petitioner, the respondent, the | ||
attorneys, and the insurers shall not be disclosed.
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(3) Reports required under this
subsection (C-5) shall | ||
be filed with the Secretary no later than September 1 in | ||
2006 and no later than September 1 of each year thereafter.
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(D) In addition to the information which may be requested | ||
under
subsection (C), the Director may also request on a | ||
companywide, aggregate
basis, Federal Income Tax recoverable, | ||
net realized capital gain or loss,
net unrealized capital gain |
or loss, and all other expenses not requested
in subsection (C) | ||
above.
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(E) Violations - Suspensions - Revocations.
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(1) Any company or person
subject to this Article, who | ||
willfully or repeatedly fails to observe or who
otherwise | ||
violates any of the provisions of this Article or any rule | ||
or
regulation promulgated by the Director under authority | ||
of this Article or any
final order of the Director entered | ||
under the authority of this Article shall
by civil penalty | ||
forfeit to the State of Illinois a sum not to exceed
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$2,000. Each day during which a violation occurs | ||
constitutes a
separate
offense.
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(2) No forfeiture liability under paragraph (1) of this | ||
subsection may
attach unless a written notice of apparent | ||
liability has been issued by the
Director and received by | ||
the respondent, or the Director sends written
notice of | ||
apparent liability by registered or certified mail, return
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receipt requested, to the last known address of the | ||
respondent. Any
respondent so notified must be granted an | ||
opportunity to request a hearing
within 10 days from | ||
receipt of notice, or to show in writing, why he should
not | ||
be held liable. A notice issued under this Section must set | ||
forth the
date, facts and nature of the act or omission | ||
with which the respondent is
charged and must specifically | ||
identify the particular provision of this
Article, rule, | ||
regulation or order of which a violation is charged.
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(3) No forfeiture liability under paragraph (1) of this | ||
subsection may
attach for any violation occurring more than | ||
2 years prior to the date of
issuance of the notice of | ||
apparent liability and in no event may the total
civil | ||
penalty forfeiture imposed for the acts or omissions set | ||
forth in any
one notice of apparent liability exceed | ||
$100,000.
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(4) All administrative hearings conducted pursuant to | ||
this Article are
subject to 50 Ill. Adm. Code 2402 and all | ||
administrative hearings are
subject to the Administrative |
Review Law.
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(5) The civil penalty forfeitures provided for in this | ||
Section are
payable to the General Revenue Fund of the | ||
State of Illinois, and may be
recovered in a civil suit in | ||
the name of the State of Illinois brought in
the Circuit | ||
Court in Sangamon County or in the Circuit Court of the | ||
county
where the respondent is domiciled or has its | ||
principal operating office.
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(6) In any case where the Director issues a notice of | ||
apparent liability
looking toward the imposition of a civil | ||
penalty forfeiture under this
Section that fact may not be | ||
used in any other proceeding before the
Director to the | ||
prejudice of the respondent to whom the notice was issued,
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unless (a) the civil penalty forfeiture has been paid, or | ||
(b) a court has
ordered payment of the civil penalty | ||
forfeiture and that order has become
final.
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(7) When any person or company has a license or | ||
certificate of authority
under this Code and knowingly | ||
fails or refuses to comply with a lawful
order of the | ||
Director requiring compliance with this Article, entered | ||
after
notice and hearing, within the period of time | ||
specified in the order, the
Director may, in addition to | ||
any other penalty or authority
provided, revoke or refuse | ||
to renew the license or certificate of authority
of such | ||
person
or company, or may suspend the license or | ||
certificate of authority
of such
person or company until | ||
compliance with such order has been obtained.
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(8) When any person or company has a license or | ||
certificate of authority
under this Code and knowingly | ||
fails or refuses to comply with any
provisions of this | ||
Article, the Director may, after notice and hearing, in
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addition to any other penalty provided, revoke or refuse to | ||
renew the
license or certificate of authority of such | ||
person or company, or may
suspend the license or | ||
certificate of authority of such person or company,
until | ||
compliance with such provision of this Article has been |
obtained.
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(9) No suspension or revocation under this Section may | ||
become effective
until 5 days from the date that the notice | ||
of suspension or revocation has
been personally delivered | ||
or delivered by registered or certified mail to
the company | ||
or person. A suspension or revocation under this Section is
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stayed upon the filing, by the company or person, of a | ||
petition for
judicial review under the Administrative | ||
Review Law.
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(Source: P.A. 93-32, eff. 7-1-03.)
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Section 10. The Workers' Compensation Act is amended by | ||
changing Sections 4, 7, 8, 12, 13, 13.1, 14, 16, and 19 and by | ||
adding Sections 8.2, 8.3, 8.7, and 25.5 as follows:
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(820 ILCS 305/4) (from Ch. 48, par. 138.4)
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Sec. 4. (a) Any employer, including but not limited to | ||
general contractors
and their subcontractors, who shall come | ||
within the provisions of
Section 3 of this Act, and any other | ||
employer who shall elect to provide
and pay the compensation | ||
provided for in this Act shall:
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(1) File with the Commission annually an application | ||
for approval as a
self-insurer which shall include a | ||
current financial statement, and
annually, thereafter, an | ||
application for renewal of self-insurance, which
shall | ||
include a current financial statement. Said
application | ||
and financial statement shall be signed and sworn to by the
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president or vice president and secretary or assistant | ||
secretary of the
employer if it be a corporation, or by all | ||
of the partners, if it be a
copartnership, or by the owner | ||
if it be neither a copartnership nor a
corporation. All | ||
initial applications and all applications for renewal of
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self-insurance must be submitted at least 60 days prior to | ||
the requested
effective date of self-insurance. An | ||
employer may elect to provide and pay
compensation as | ||
provided
for in this Act as a member of a group workers' |
compensation pool under Article
V 3/4 of the Illinois | ||
Insurance Code. If an employer becomes a member of a
group | ||
workers' compensation pool, the employer shall not be | ||
relieved of any
obligations imposed by this Act.
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If the sworn application and financial statement of any | ||
such employer
does not satisfy the Commission of the | ||
financial ability of the employer
who has filed it, the | ||
Commission shall require such employer to,
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(2) Furnish security, indemnity or a bond guaranteeing | ||
the payment
by the employer of the compensation provided | ||
for in this Act, provided
that any such employer whose | ||
application and financial statement shall
not have | ||
satisfied the commission of his or her financial ability | ||
and
who shall have secured his liability in part by excess | ||
liability insurance
shall be required to furnish to the | ||
Commission security, indemnity or bond
guaranteeing his or | ||
her payment up to the effective limits of the excess
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coverage, or
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(3) Insure his entire liability to pay such | ||
compensation in some
insurance carrier authorized, | ||
licensed, or permitted to do such
insurance business in | ||
this State. Every policy of an insurance carrier,
insuring | ||
the payment of compensation under this Act shall cover all | ||
the
employees and the entire compensation liability of the | ||
insured:
Provided, however, that any employer may insure | ||
his or her compensation
liability with 2 or more insurance | ||
carriers or may insure a part and
qualify under subsection | ||
1, 2, or 4 for the remainder of his or her
liability to pay | ||
such compensation, subject to the following two | ||
provisions:
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Firstly, the entire compensation liability of the | ||
employer to
employees working at or from one location | ||
shall be insured in one such
insurance carrier or shall | ||
be self-insured, and
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Secondly, the employer shall submit evidence | ||
satisfactorily to the
Commission that his or her entire |
liability for the compensation provided
for in this Act | ||
will be secured. Any provisions in any policy, or in | ||
any
endorsement attached thereto, attempting to limit | ||
or modify in any way,
the liability of the insurance | ||
carriers issuing the same except as
otherwise provided | ||
herein shall be wholly void.
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Nothing herein contained shall apply to policies of | ||
excess liability
carriage secured by employers who have | ||
been approved by the Commission
as self-insurers, or
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(4) Make some other provision, satisfactory to the | ||
Commission, for
the securing of the payment of compensation | ||
provided for in this Act,
and
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(5) Upon becoming subject to this Act and thereafter as | ||
often as the
Commission may in writing demand, file with | ||
the Commission in form prescribed
by it evidence of his or | ||
her compliance with the provision of this Section.
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(a-1) Regardless of its state of domicile or its principal | ||
place of
business, an employer shall make payments to its | ||
insurance carrier or group
self-insurance fund, where | ||
applicable, based upon the premium rates of the
situs where the | ||
work or project is located in Illinois if:
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(A) the employer is engaged primarily in the building | ||
and
construction industry; and
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(B) subdivision (a)(3) of this Section applies to the | ||
employer or
the employer is a member of a group | ||
self-insurance plan as defined in
subsection (1) of Section | ||
4a.
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The Illinois Workers' Compensation Commission shall impose | ||
a penalty upon an employer
for violation of this subsection | ||
(a-1) if:
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(i) the employer is given an opportunity at a hearing | ||
to present
evidence of its compliance with this subsection | ||
(a-1); and
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(ii) after the hearing, the Commission finds that the | ||
employer
failed to make payments upon the premium rates of | ||
the situs where the work or
project is located in Illinois.
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The penalty shall not exceed $1,000 for each day of work | ||
for which
the employer failed to make payments upon the premium | ||
rates of the situs where
the
work or project is located in | ||
Illinois, but the total penalty shall not exceed
$50,000 for | ||
each project or each contract under which the work was
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performed.
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Any penalty under this subsection (a-1) must be imposed not | ||
later
than one year after the expiration of the applicable | ||
limitation period
specified in subsection (d) of Section 6 of | ||
this Act. Penalties imposed under
this subsection (a-1) shall | ||
be deposited into the Illinois Workers' Compensation | ||
Commission
Operations Fund, a special fund that is created in | ||
the State treasury. Subject
to appropriation, moneys in the | ||
Fund shall be used solely for the operations
of the Illinois | ||
Workers' Compensation Commission.
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(b) The sworn application and financial statement, or | ||
security,
indemnity or bond, or amount of insurance, or other | ||
provisions, filed,
furnished, carried, or made by the employer, | ||
as the case may be, shall
be subject to the approval of the | ||
Commission.
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Deposits under escrow agreements shall be cash, negotiable | ||
United
States government bonds or negotiable general | ||
obligation bonds of the
State of Illinois. Such cash or bonds | ||
shall be deposited in
escrow with any State or National Bank or | ||
Trust Company having trust
authority in the State of Illinois.
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Upon the approval of the sworn application and financial | ||
statement,
security, indemnity or bond or amount of insurance, | ||
filed, furnished or
carried, as the case may be, the Commission | ||
shall send to the employer
written notice of its approval | ||
thereof. The certificate of compliance
by the employer with the | ||
provisions of subparagraphs (2) and (3) of
paragraph (a) of | ||
this Section shall be delivered by the insurance
carrier to the | ||
Illinois Workers' Compensation Commission within five days | ||
after the
effective date of the policy so certified. The | ||
insurance so certified
shall cover all compensation liability | ||
occurring during the time that
the insurance is in effect and |
no further certificate need be filed in case
such insurance is | ||
renewed, extended or otherwise continued by such
carrier. The | ||
insurance so certified shall not be cancelled or in the
event | ||
that such insurance is not renewed, extended or otherwise
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continued, such insurance shall not be terminated until at | ||
least 10
days after receipt by the Illinois Workers' | ||
Compensation Commission of notice of the
cancellation or | ||
termination of said insurance; provided, however, that
if the | ||
employer has secured insurance from another insurance carrier, | ||
or
has otherwise secured the payment of compensation in | ||
accordance with
this Section, and such insurance or other | ||
security becomes effective
prior to the expiration of the 10 | ||
days, cancellation or termination may, at
the option of the | ||
insurance carrier indicated in such notice, be effective
as of | ||
the effective date of such other insurance or security.
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(c) Whenever the Commission shall find that any | ||
corporation,
company, association, aggregation of individuals, | ||
reciprocal or
interinsurers exchange, or other insurer | ||
effecting workers' compensation
insurance in this State shall | ||
be insolvent, financially unsound, or
unable to fully meet all | ||
payments and liabilities assumed or to be
assumed for | ||
compensation insurance in this State, or shall practice a
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policy of delay or unfairness toward employees in the | ||
adjustment,
settlement, or payment of benefits due such | ||
employees, the Commission
may after reasonable notice and | ||
hearing order and direct that such
corporation, company, | ||
association, aggregation of individuals,
reciprocal or | ||
interinsurers exchange, or insurer, shall from and after a
date | ||
fixed in such order discontinue the writing of any such | ||
workers'
compensation insurance in this State. Subject to such | ||
modification of
the order as the Commission may later make on | ||
review of the order,
as herein provided, it shall thereupon be | ||
unlawful for any such
corporation, company, association, | ||
aggregation of individuals,
reciprocal or interinsurers | ||
exchange, or insurer to effect any workers'
compensation | ||
insurance in this State. A copy of the order shall be served
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upon the Director of Insurance by registered mail. Whenever the | ||
Commission
finds that any service or adjustment company used or | ||
employed
by a self-insured employer or by an insurance carrier | ||
to process,
adjust, investigate, compromise or otherwise | ||
handle claims under this
Act, has practiced or is practicing a | ||
policy of delay or unfairness
toward employees in the | ||
adjustment, settlement or payment of benefits
due such | ||
employees, the Commission may after reasonable notice and
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hearing order and direct that such service or adjustment | ||
company shall
from and after a date fixed in such order be | ||
prohibited from processing,
adjusting, investigating, | ||
compromising or otherwise handling claims
under this Act.
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Whenever the Commission finds that any self-insured | ||
employer has
practiced or is practicing delay or unfairness | ||
toward employees in the
adjustment, settlement or payment of | ||
benefits due such employees, the
Commission may, after | ||
reasonable notice and hearing, order and direct
that after a | ||
date fixed in the order such self-insured employer shall be
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disqualified to operate as a self-insurer and shall be required | ||
to
insure his entire liability to pay compensation in some | ||
insurance
carrier authorized, licensed and permitted to do such | ||
insurance business
in this State, as provided in subparagraph 3 | ||
of paragraph (a) of this
Section.
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All orders made by the Commission under this Section shall | ||
be subject
to review by the courts, said review to be taken in | ||
the same manner and
within the same time as provided by Section | ||
19 of this Act for review of
awards and decisions of the | ||
Commission, upon the party seeking the
review filing with the | ||
clerk of the court to which said review is taken
a bond in an | ||
amount to be fixed and approved by the court to which the
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review is taken, conditioned upon the payment of all | ||
compensation awarded
against the person taking said review | ||
pending a decision thereof and
further conditioned upon such | ||
other obligations as the court may impose.
Upon the review the | ||
Circuit Court shall have power to review all questions
of fact | ||
as well as of law. The penalty hereinafter provided for in this
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paragraph shall not attach and shall not begin to run until the | ||
final
determination of the order of the Commission.
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(d) Whenever a panel of 3 Commissioners comprised of one | ||
member of the employing class, one member of the employee | ||
class, and one member not identified with either the employing | ||
or employee class, with due process and after a hearing, | ||
determines an employer has knowingly failed to provide coverage | ||
as required by paragraph (a) of this Section, the failure shall | ||
be deemed an immediate serious danger to public health, safety, | ||
and welfare sufficient to justify service by the Commission of | ||
a work-stop order on such employer, requiring the cessation of | ||
all business operations of such employer at the place of | ||
employment or job site. Any law enforcement agency in the State | ||
shall, at the request of the Commission, render any assistance | ||
necessary to carry out the provisions of this Section, | ||
including, but not limited to, preventing any employee of such | ||
employer from remaining at a place of employment or job site | ||
after a work-stop order has taken effect. Any work-stop order | ||
shall be lifted upon proof of insurance as required by this | ||
Act. Any orders under this Section are appealable under Section | ||
19(f) to the Circuit Court.
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Any individual employer, corporate officer or director of a | ||
corporate employer, partner of an employer partnership, or | ||
member of an employer limited liability company who knowingly | ||
fails to provide coverage as required by paragraph (a) of this | ||
Section is guilty of a Class 4 felony. This provision shall not | ||
apply to any corporate officer or director of any | ||
publicly-owned corporation. Each day's violation constitutes a | ||
separate offense. The State's Attorney of the county in which | ||
the violation occurred, or the Attorney General, shall bring | ||
such actions in the name of the People of the State of | ||
Illinois, or may, in addition to other remedies provided in | ||
this Section, bring an action for an injunction to restrain the | ||
violation or to enjoin the operation of any such employer.
| ||
Any individual employer, corporate officer or director of a | ||
corporate employer, partner of an employer partnership, or |
member of an employer limited liability company who negligently | ||
fails to provide coverage as required by paragraph (a) of this | ||
Section is guilty of a Class A misdemeanor. This provision | ||
shall not apply to any corporate officer or director of any | ||
publicly-owned corporation. Each day's violation constitutes a | ||
separate offense. The State's Attorney of the county in which | ||
the violation occurred, or the Attorney General, shall bring | ||
such actions in the name of the People of the State of | ||
Illinois.
| ||
The criminal penalties in this subsection (d) shall not | ||
apply where
there exists a good faith dispute as to the | ||
existence of an
employment relationship. Evidence of good faith | ||
shall
include, but not be limited to, compliance with the | ||
definition
of employee as used by the Internal Revenue Service.
| ||
Employers who are subject to and who knowingly fail to | ||
comply with this Section shall not be entitled to the benefits | ||
of this Act during the period of noncompliance, but shall be | ||
liable in an action under any other applicable law of this | ||
State. In the action, such employer shall not avail himself or | ||
herself of the defenses of assumption of risk or negligence or | ||
that the injury was due to a co-employee. In the action, proof | ||
of the injury shall constitute prima facie evidence of | ||
negligence on the part of such employer and the burden shall be | ||
on such employer to show freedom of negligence resulting in the | ||
injury. The employer shall not join any other defendant in any | ||
such civil action. Nothing in this amendatory Act of the 94th | ||
General Assembly shall affect the employee's rights under | ||
subdivision (a)3 of Section 1 of this Act. Any employer or | ||
carrier who makes payments under subdivision (a)3 of Section 1 | ||
of this Act shall have a right of reimbursement from the | ||
proceeds of any recovery under this Section.
| ||
An employee of an uninsured employer, or the employee's | ||
dependents in case death ensued, may, instead of proceeding | ||
against the employer in a civil action in court, file an | ||
application for adjustment of claim with the Commission in | ||
accordance with the provisions of this Act and the Commission |
shall hear and determine the application for adjustment of | ||
claim in the manner in which other claims are heard and | ||
determined before the Commission.
| ||
All proceedings under this subsection (d) shall be reported | ||
on an annual basis to the Workers' Compensation Advisory Board.
| ||
Upon a finding by the Commission, after reasonable notice | ||
and
hearing, of the knowing and wilful failure or refusal of an | ||
employer to
comply with
any of the provisions of paragraph (a) | ||
of this Section or the failure or
refusal of an employer, | ||
service or adjustment company, or an insurance
carrier to | ||
comply with any order of the Illinois Workers' Compensation | ||
Commission pursuant to
paragraph (c) of this Section | ||
disqualifying him or her to operate as a self
insurer and | ||
requiring him or her to insure his or her liability, the
| ||
Commission may assess a civil penalty of up to $500 per day for | ||
each day of
such failure or refusal after the effective date of | ||
this amendatory Act of
1989. The minimum penalty under this | ||
Section shall be the sum of $10,000.
Each day of such failure | ||
or refusal shall constitute a separate offense.
The Commission | ||
may assess the civil penalty personally and individually
| ||
against the corporate officers and directors of a corporate | ||
employer, the
partners of an employer partnership, and the | ||
members of an employer limited
liability company, after a | ||
finding of a knowing and willful refusal or failure
of each | ||
such named corporate officer, director, partner, or member to | ||
comply
with this Section. The liability for the assessed | ||
penalty shall be
against the named employer first, and
if the | ||
named employer fails or refuses to pay the penalty to the
| ||
Commission within 30 days after the final order of the | ||
Commission, then the
named
corporate officers, directors, | ||
partners, or members who have been found to have
knowingly and | ||
willfully refused or failed to comply with this Section shall | ||
be
liable for the unpaid penalty or any unpaid portion of the | ||
penalty. Upon investigation by the insurance non-compliance | ||
unit of the Commission, the Attorney General shall have the | ||
authority to prosecute all proceedings to enforce the civil and |
administrative provisions of this Section before the | ||
Commission. The Commission shall promulgate procedural rules | ||
for enforcing this Section.
All
penalties collected under
this | ||
Section shall be deposited in the Illinois Workers' | ||
Compensation Commission Operations Fund.
| ||
Upon the failure or refusal of any employer, service or | ||
adjustment
company or insurance carrier to comply with the | ||
provisions of this Section
and with the orders of the | ||
Commission under this Section, or the order of
the court on | ||
review after final adjudication, the Commission may bring a
| ||
civil action to recover the amount of the penalty in Cook | ||
County or in
Sangamon County in which litigation the Commission | ||
shall be represented by
the Attorney General. The Commission | ||
shall send notice of its finding of
non-compliance and | ||
assessment of the civil penalty to the Attorney General.
It | ||
shall be the duty of the Attorney General within 30 days after | ||
receipt
of the notice, to institute prosecutions and promptly | ||
prosecute all
reported violations of this Section.
| ||
Any individual employer, corporate officer or director of a | ||
corporate employer, partner of an employer partnership, or | ||
member of an employer limited liability company who, with the | ||
intent to avoid payment of compensation under this Act to an | ||
injured employee or the employee's dependents, knowingly | ||
transfers, sells, encumbers, assigns, or in any manner disposes | ||
of, conceals, secretes, or destroys any property belonging to | ||
the employer, officer, director, partner, or member is guilty | ||
of a Class 4 felony.
| ||
Penalties and fines collected pursuant to this paragraph | ||
(d) shall be deposited upon receipt into a special fund which | ||
shall be designated the Injured Workers' Benefit Fund, of which | ||
the State Treasurer is ex-officio custodian, such special fund | ||
to be held and disbursed in accordance with this paragraph (d) | ||
for the purposes hereinafter stated in this paragraph (d), upon | ||
the final order of the Commission. The Injured Workers' Benefit | ||
Fund shall be deposited the same as are State funds and any | ||
interest accruing thereon shall be added thereto every 6 |
months. The Injured Workers' Benefit Fund is subject to audit | ||
the same as State funds and accounts and is protected by the | ||
general bond given by the State Treasurer. The Injured Workers' | ||
Benefit Fund is considered always appropriated for the purposes | ||
of disbursements as provided in this paragraph, and shall be | ||
paid out and disbursed as herein provided and shall not at any | ||
time be appropriated or diverted to any other use or purpose. | ||
Moneys in the Injured Workers' Benefit Fund shall be used only | ||
for payment of workers' compensation benefits for injured | ||
employees when the employer has failed to provide coverage as | ||
determined under this paragraph (d) and has failed to pay the | ||
benefits due to the injured employee. The Commission shall have | ||
the right to obtain reimbursement from the employer for | ||
compensation obligations paid by the Injured Workers' Benefit | ||
Fund. Any such amounts obtained shall be deposited by the | ||
Commission into the Injured Workers' Benefit Fund. If an | ||
injured employee or his or her personal representative receives | ||
payment from the Injured Workers' Benefit Fund, the State of | ||
Illinois has the same rights under paragraph (b) of Section 5 | ||
that the employer who failed to pay the benefits due to the | ||
injured employee would have had if the employer had paid those | ||
benefits, and any moneys recovered by the State as a result of | ||
the State's exercise of its rights under paragraph (b) of | ||
Section 5 shall be deposited into the Injured Workers' Benefit | ||
Fund. The custodian of the Injured Workers' Benefit Fund shall | ||
be joined with the employer as a party respondent in the | ||
application for adjustment of claim. After July 1, 2006, the | ||
Commission shall make disbursements from the Fund once each | ||
year to each eligible claimant. An eligible claimant is an | ||
injured worker who has within the previous fiscal year obtained | ||
a final award for benefits from the Commission against the | ||
employer and the Injured Workers' Benefit Fund and has notified | ||
the Commission within 90 days of receipt of such award. Within | ||
a reasonable time after the end of each fiscal year, the | ||
Commission shall make a disbursement to each eligible claimant. | ||
At the time of disbursement, if there are insufficient moneys |
in the Fund to pay all claims, each eligible claimant shall | ||
receive a pro-rata share, as determined by the Commission, of | ||
the available moneys in the Fund for that year. Payment from | ||
the Injured Workers' Benefit Fund to an eligible claimant | ||
pursuant to this provision shall discharge the obligations of | ||
the Injured Workers' Benefit Fund regarding the award entered | ||
by the Commission.
| ||
(e) This Act shall not affect or disturb the continuance of | ||
any
existing insurance, mutual aid, benefit, or relief | ||
association or
department, whether maintained in whole or in | ||
part by the employer or
whether maintained by the employees, | ||
the payment of benefits of such
association or department being | ||
guaranteed by the employer or by some
person, firm or | ||
corporation for him or her: Provided, the employer contributes
| ||
to such association or department an amount not less than the | ||
full
compensation herein provided, exclusive of the cost of the | ||
maintenance
of such association or department and without any | ||
expense to the
employee. This Act shall not prevent the | ||
organization and maintaining
under the insurance laws of this | ||
State of any benefit or insurance
company for the purpose of | ||
insuring against the compensation provided
for in this Act, the | ||
expense of which is maintained by the employer.
This Act shall | ||
not prevent the organization or maintaining under the
insurance | ||
laws of this State of any voluntary mutual aid, benefit or
| ||
relief association among employees for the payment of | ||
additional
accident or sick benefits.
| ||
(f) No existing insurance, mutual aid, benefit or relief | ||
association
or department shall, by reason of anything herein | ||
contained, be
authorized to discontinue its operation without | ||
first discharging its
obligations to any and all persons | ||
carrying insurance in the same or
entitled to relief or | ||
benefits therein.
| ||
(g) Any contract, oral, written or implied, of employment | ||
providing
for relief benefit, or insurance or any other device | ||
whereby the
employee is required to pay any premium or premiums | ||
for insurance
against the compensation provided for in this Act |
shall be null and
void. Any employer withholding from the wages | ||
of any employee any
amount for the purpose of paying any such | ||
premium shall be guilty of a
Class B misdemeanor.
| ||
In the event the employer does not pay the compensation for | ||
which he or
she is liable, then an insurance company, | ||
association or insurer which may
have insured such employer | ||
against such liability shall become primarily
liable to pay to | ||
the employee, his or her personal representative or
beneficiary | ||
the compensation required by the provisions of this Act to
be | ||
paid by such employer. The insurance carrier may be made a | ||
party to
the proceedings in which the employer is a party and | ||
an award may be
entered jointly against the employer and the | ||
insurance carrier.
| ||
(h) It shall be unlawful for any employer, insurance | ||
company or
service or adjustment company to interfere with, | ||
restrain or coerce an
employee in any manner whatsoever in the | ||
exercise of the rights or
remedies granted to him or her by | ||
this Act or to discriminate, attempt to
discriminate, or | ||
threaten to discriminate against an employee in any way
because | ||
of his or her exercise of the rights or remedies granted to
him | ||
or her by this Act.
| ||
It shall be unlawful for any employer, individually or | ||
through any
insurance company or service or adjustment company, | ||
to discharge or to
threaten to discharge, or to refuse to | ||
rehire or recall to active
service in a suitable capacity an | ||
employee because of the exercise of
his or her rights or | ||
remedies granted to him or her by this Act.
| ||
(i) If an employer elects to obtain a life insurance policy | ||
on his
employees, he may also elect to apply such benefits in | ||
satisfaction of all
or a portion of the death benefits payable | ||
under this Act, in which case,
the employer's compensation | ||
premium shall be reduced accordingly.
| ||
(j) Within 45 days of receipt of an initial application or | ||
application
to renew self-insurance privileges the | ||
Self-Insurers Advisory Board shall
review and submit for | ||
approval by the Chairman of the Commission
recommendations of |
disposition of all initial applications to self-insure
and all | ||
applications to renew self-insurance privileges filed by | ||
private
self-insurers pursuant to the provisions of this | ||
Section and Section 4a-9
of this Act. Each private self-insurer | ||
shall submit with its initial and
renewal applications the | ||
application fee required by Section 4a-4 of this Act.
| ||
The Chairman of the Commission shall promptly act upon all | ||
initial
applications and applications for renewal in full | ||
accordance with the
recommendations of the Board or, should the | ||
Chairman disagree with any
recommendation of disposition of the | ||
Self-Insurer's Advisory Board, he
shall within 30 days of | ||
receipt of such recommendation provide to the Board
in writing | ||
the reasons supporting his decision. The Chairman shall also
| ||
promptly notify the employer of his decision within 15 days of | ||
receipt of
the recommendation of the Board.
| ||
If an employer is denied a renewal of self-insurance | ||
privileges pursuant
to application it shall retain said | ||
privilege for 120 days after receipt of
a notice of | ||
cancellation of the privilege from the Chairman of the | ||
Commission.
| ||
All orders made by the Chairman under this Section shall be | ||
subject to
review by the courts, such review to be taken in the | ||
same manner and within
the same time as provided by subsection | ||
(f) of Section 19 of this Act for
review of awards and | ||
decisions of the Commission, upon the party seeking
the review | ||
filing with the clerk of the court to which such review is | ||
taken
a bond in an amount to be fixed and approved by the court | ||
to which the
review is taken, conditioned upon the payment of | ||
all compensation awarded
against the person taking such review | ||
pending a decision thereof and
further conditioned upon such | ||
other obligations as the court may impose.
Upon the review the | ||
Circuit Court shall have power to review all questions
of fact | ||
as well as of law.
| ||
(Source: P.A. 92-324, eff. 8-9-01; 93-721, eff. 1-1-05.)
| ||
(820 ILCS 305/7) (from Ch. 48, par. 138.7)
|
Sec. 7. The amount of compensation which shall be paid for | ||
an
accidental injury to the employee resulting in death is:
| ||
(a) If the employee leaves surviving a widow, widower, | ||
child or
children, the applicable weekly compensation rate | ||
computed in accordance
with subparagraph 2 of paragraph (b) of | ||
Section 8, shall be payable
during the life of the widow or | ||
widower and if any surviving child or
children shall not be | ||
physically or mentally incapacitated then until
the death of | ||
the widow or widower or until the youngest child shall
reach | ||
the age of 18, whichever shall come later; provided that if | ||
such
child or children shall be enrolled as a full time student | ||
in any
accredited educational institution, the payments shall | ||
continue until
such child has attained the age of 25. In the | ||
event any surviving child
or children shall be physically or | ||
mentally incapacitated, the payments
shall continue for the | ||
duration of such incapacity.
| ||
The term "child" means a child whom the deceased employee | ||
left
surviving, including a posthumous child, a child legally | ||
adopted, a
child whom the deceased employee was legally | ||
obligated to support or a
child to whom the deceased employee | ||
stood in loco parentis. The term
"children" means the plural of | ||
"child".
| ||
The term "physically or mentally incapacitated child or | ||
children"
means a child or children incapable of engaging in | ||
regular and
substantial gainful employment.
| ||
In the event of the remarriage of a widow or widower, where | ||
the
decedent did not leave surviving any child or children who, | ||
at the time
of such remarriage, are entitled to compensation | ||
benefits under this
Act, the surviving spouse shall be paid a | ||
lump sum equal to 2 years
compensation benefits and all further | ||
rights of such widow or widower
shall be extinguished.
| ||
If the employee leaves surviving any child or children | ||
under 18 years
of age who at the time of death shall be | ||
entitled to compensation under
this paragraph (a) of this | ||
Section, the weekly compensation payments
herein provided for | ||
such child or children shall in any event continue
for a period |
of not less than 6 years.
| ||
Any beneficiary entitled to compensation under this | ||
paragraph (a) of
this Section shall receive from the special | ||
fund provided in paragraph
(f) of this Section, in addition to | ||
the compensation herein provided,
supplemental benefits in | ||
accordance with paragraph (g) of Section 8.
| ||
(b) If no compensation is payable under paragraph (a) of | ||
this
Section and the employee leaves surviving a parent or | ||
parents who at the
time of the accident were totally dependent | ||
upon the earnings of the
employee then weekly payments equal to | ||
the compensation rate payable in
the case where the employee | ||
leaves surviving a widow or widower, shall
be paid to such | ||
parent or parents for the duration of their lives, and
in the | ||
event of the death of either, for the life of the survivor.
| ||
(c) If no compensation is payable under paragraphs (a) or | ||
(b) of
this Section and the employee leaves surviving any child | ||
or children who
are not entitled to compensation under the | ||
foregoing paragraph (a) but
who at the time of the accident | ||
were nevertheless in any manner
dependent upon the earnings of | ||
the employee, or leaves surviving a
parent or parents who at | ||
the time of the accident were partially
dependent upon the | ||
earnings of the employee, then there shall be paid to
such | ||
dependent or dependents for a period of 8 years weekly | ||
compensation
payments at such proportion of the applicable rate | ||
if the employee had
left surviving a widow or widower as such | ||
dependency bears to total
dependency. In the event of the death | ||
of any such beneficiary the share
of such beneficiary shall be | ||
divided equally among the surviving
beneficiaries and in the | ||
event of the death of the last such
beneficiary all the rights | ||
under this paragraph shall be extinguished.
| ||
(d) If no compensation is payable under paragraphs (a), (b) | ||
or (c)
of this Section and the employee leaves surviving any | ||
grandparent,
grandparents, grandchild or grandchildren or | ||
collateral heirs dependent
upon the employee's earnings to the | ||
extent of 50% or more of total
dependency, then there shall be | ||
paid to such dependent or dependents for
a period of 5 years |
weekly compensation payments at such proportion of
the | ||
applicable rate if the employee had left surviving a widow or
| ||
widower as such dependency bears to total dependency. In the | ||
event of
the death of any such beneficiary the share of such | ||
beneficiary shall be
divided equally among the surviving | ||
beneficiaries and in the event of
the death of the last such | ||
beneficiary all rights hereunder shall be
extinguished.
| ||
(e) The compensation to be paid for accidental injury which | ||
results
in death, as provided in this Section, shall be paid to | ||
the persons who
form the basis for determining the amount of | ||
compensation to be paid by
the employer, the respective shares | ||
to be in the proportion of their
respective dependency at the | ||
time of the accident on the earnings of the
deceased. The | ||
Commission or an Arbitrator thereof may, in its or his
| ||
discretion, order or award the payment to the parent or | ||
grandparent of a
child for the latter's support the amount of | ||
compensation which but for
such order or award would have been | ||
paid to such child as its share of
the compensation payable, | ||
which order or award may be modified from time
to time by the | ||
Commission in its discretion with respect to the person
to whom | ||
shall be paid the amount of the order or award remaining unpaid
| ||
at the time of the modification.
| ||
The payments of compensation by the employer in accordance | ||
with the
order or award of the Commission discharges such | ||
employer from all
further obligation as to such compensation.
| ||
(f) The sum of $8,000
$4200 for burial expenses shall be | ||
paid by the
employer to the widow or widower, other dependent, | ||
next of kin or to the
person or persons incurring the expense | ||
of burial.
| ||
In the event the employer failed to provide necessary first | ||
aid,
medical, surgical or hospital service, he shall pay the | ||
cost thereof to
the person or persons entitled to compensation | ||
under paragraphs (a),
(b), (c) or (d) of this Section, or to | ||
the person or persons incurring
the obligation therefore, or | ||
providing the same.
| ||
On January 15 and July 15, 1981, and on January 15 and July |
15 of each
year thereafter the employer shall within 60 days | ||
pay a sum equal to
1/8 of 1% of all compensation payments made | ||
by him after July 1, 1980, either
under this Act or the | ||
Workers' Occupational Diseases Act, whether by lump
sum | ||
settlement or weekly compensation payments, but not including | ||
hospital,
surgical or rehabilitation payments, made during the | ||
first 6 months and
during the second 6 months respectively of | ||
the fiscal year next preceding
the date of the payments, into a | ||
special fund which shall be designated the
"Second Injury | ||
Fund", of which the State Treasurer is ex-officio custodian,
| ||
such special fund to be held and disbursed for the purposes | ||
hereinafter
stated in paragraphs (f) and (g) of Section 8, | ||
either upon the order of the
Commission or of a competent | ||
court. Said special fund shall be deposited
the same as are | ||
State funds and any interest accruing thereon shall be
added | ||
thereto every 6 months. It is subject to audit the same as | ||
State
funds and accounts and is protected by the General bond | ||
given by the State
Treasurer. It is considered always | ||
appropriated for the purposes of
disbursements as provided in | ||
Section 8, paragraph (f), of this Act, and
shall be paid out | ||
and disbursed as therein provided and shall not at any
time be | ||
appropriated or diverted to any other use or purpose.
| ||
On January 15, 1991, the employer shall further pay a sum | ||
equal to one
half of 1% of all compensation payments made by | ||
him from January 1, 1990
through June 30, 1990 either under | ||
this Act or under the Workers'
Occupational Diseases Act, | ||
whether by lump sum settlement or weekly
compensation payments, | ||
but not including hospital, surgical or
rehabilitation | ||
payments, into an additional Special Fund which shall be
| ||
designated as the "Rate Adjustment Fund". On March 15, 1991, | ||
the employer
shall pay into the Rate Adjustment Fund a sum | ||
equal to one half of 1% of
all such compensation payments made | ||
from July 1, 1990 through December 31,
1990. Within 60 days | ||
after July 15, 1991, the employer shall pay into the
Rate | ||
Adjustment Fund a sum equal to one half of 1% of all such | ||
compensation
payments made from January 1, 1991 through June |
30, 1991. Within 60 days
after January 15 of 1992 and each
| ||
subsequent year through 1996, the employer shall pay
into the | ||
Rate Adjustment Fund a sum equal to one half of 1% of all such
| ||
compensation payments made in the last 6 months of the | ||
preceding calendar
year. Within 60 days after July 15 of 1992 | ||
and each subsequent year through
1995, the employer shall pay | ||
into the Rate Adjustment Fund a sum equal to one
half of 1% of | ||
all such compensation payments made in the first 6 months of | ||
the
same calendar year. Within 60 days after January 15 of 1997 | ||
and each subsequent
year through 2005 , the employer shall pay | ||
into the Rate Adjustment Fund a sum equal to
three-fourths of | ||
1% of all such compensation payments made in the last 6 months
| ||
of the preceding calendar year. Within 60 days after July 15 of | ||
1996 and each
subsequent year through 2004 , the employer shall | ||
pay into the Rate Adjustment Fund a sum
equal to three-fourths | ||
of 1% of all such compensation payments made in the
first 6 | ||
months of the same calendar year. Within 60 days after January | ||
15 of 2006 and each subsequent year, the employer shall pay | ||
into the Rate Adjustment Fund a sum equal to 1% of such | ||
compensation payments made in the last 6 months of the | ||
preceding calendar year. Within 60 days after July 15 of 2005 | ||
and each subsequent year, the employer shall pay into the Rate | ||
Adjustment Fund a sum equal to 1% of such compensation payments | ||
made in the first 6 months of the same calendar year. The | ||
administrative costs of
collecting assessments from employers | ||
for the Rate Adjustment Fund shall be
paid from the
Rate | ||
Adjustment Fund. The cost of an actuarial audit of the Fund | ||
shall be paid
from the Rate Adjustment Fund and the audit shall | ||
be completed no later than
July 1, 1997 . The State Treasurer is | ||
ex officio custodian of such Special
Fund and the same shall be | ||
held and disbursed for the purposes hereinafter
stated in | ||
paragraphs (f) and (g) of Section 8 upon the order of the
| ||
Commission or of a competent court. The Rate Adjustment Fund | ||
shall be
deposited the same as are State funds and any interest | ||
accruing thereon
shall be added thereto every 6 months. It | ||
shall be subject to audit the
same as State funds and accounts |
and shall be protected by the general bond
given by the State | ||
Treasurer. It is considered always appropriated for the
| ||
purposes of disbursements as provided in paragraphs (f) and (g) | ||
of Section
8 of this Act and shall be paid out and disbursed as | ||
therein provided and
shall not at any time be appropriated or | ||
diverted to any other use or
purpose. Within 5 days after the | ||
effective date of this amendatory Act of
1990, the Comptroller | ||
and the State Treasurer shall transfer $1,000,000
from the | ||
General Revenue Fund to the Rate Adjustment Fund. By February | ||
15,
1991, the Comptroller and the State Treasurer shall | ||
transfer $1,000,000
from the Rate Adjustment Fund to the | ||
General Revenue Fund. The Comptroller and Treasurer are | ||
authorized to make
transfers at the
request of the Chairman up | ||
to a total of $19,000,000
$15,000,000
from the Second Injury | ||
Fund, the General Revenue Fund, and the Workers'
Compensation | ||
Benefit Trust
Fund to the Rate Adjustment Fund to the extent | ||
that there is insufficient
money in the Rate Adjustment Fund to | ||
pay claims and obligations. Amounts may
be transferred from the | ||
General Revenue Fund only if the funds in the Second
Injury | ||
Fund or the Workers' Compensation Benefit Trust Fund are | ||
insufficient to
pay claims and obligations of the Rate | ||
Adjustment Fund. All
amounts transferred from the Second Injury | ||
Fund, the General Revenue Fund,
and the Workers'
Compensation | ||
Benefit Trust Fund shall be repaid from the Rate Adjustment
| ||
Fund within 270 days of a transfer, together with interest at | ||
the rate
earned by moneys on deposit in the Fund or Funds from | ||
which the moneys were
transferred.
| ||
Upon a finding by the Commission, after reasonable notice | ||
and hearing,
that any employer has willfully and knowingly | ||
failed to pay the proper
amounts into the Second Injury Fund or | ||
the Rate Adjustment Fund required by
this Section or if such | ||
payments are not made within the time periods
prescribed by | ||
this Section, the employer shall, in addition to such
payments, | ||
pay a penalty of 20% of the amount required to be paid or | ||
$2,500,
whichever is greater, for each year or part thereof of | ||
such failure to pay.
This penalty shall only apply to |
obligations of an employer to the
Second Injury Fund or the | ||
Rate Adjustment Fund accruing after the effective
date of this | ||
amendatory Act of 1989. All or part of such a penalty may be
| ||
waived by the Commission for good cause shown.
| ||
Any obligations of an employer to the Second Injury Fund | ||
and Rate
Adjustment Fund accruing prior to the effective date | ||
of this amendatory Act
of 1989 shall be paid in full by such | ||
employer within 5 years of the
effective date of this | ||
amendatory Act of 1989, with at least one-fifth of
such | ||
obligation to be paid during each year following the effective | ||
date of
this amendatory Act of 1989. If the Commission finds, | ||
following reasonable
notice and hearing, that an employer has | ||
failed to make timely payment of
any obligation accruing under | ||
the preceding sentence, the employer shall,
in addition to all | ||
other payments required by this Section, be liable for a
| ||
penalty equal to 20% of the overdue obligation or $2,500, | ||
whichever is
greater, for each year or part thereof that | ||
obligation is overdue.
All or part of such a penalty may be | ||
waived by the Commission for
good cause shown.
| ||
The Chairman of the Illinois Workers' Compensation | ||
Commission shall, annually, furnish to the
Director of the | ||
Department of Insurance a list of the amounts paid into the
| ||
Second Injury Fund and the Rate Adjustment Fund by each | ||
insurance company
on behalf of their insured employers. The | ||
Director shall verify to the
Chairman that the amounts paid by | ||
each insurance company are accurate as
best as the Director can | ||
determine from the records available to the
Director. The | ||
Chairman shall verify that the amounts paid by each
| ||
self-insurer are accurate as best as the Chairman can determine | ||
from
records available to the Chairman. The Chairman may | ||
require each
self-insurer to provide information concerning | ||
the total compensation
payments made upon which contributions | ||
to the Second Injury Fund and the
Rate Adjustment Fund are | ||
predicated and any additional information
establishing that | ||
such payments have been made into these funds. Any
deficiencies | ||
in payments noted by the Director or Chairman shall be subject
|
to the penalty provisions of this Act.
| ||
The State Treasurer, or his duly authorized | ||
representative, shall be
named as a party to all proceedings in | ||
all cases involving claim for the
loss of, or the permanent and | ||
complete loss of the use of one eye, one
foot, one leg, one arm | ||
or one hand.
| ||
The State Treasurer or his duly authorized agent shall have | ||
the same
rights as any other party to the proceeding, including | ||
the right to
petition for review of any award. The reasonable | ||
expenses of
litigation, such as medical examinations, | ||
testimony, and transcript of
evidence, incurred by the State | ||
Treasurer or his duly authorized
representative, shall be borne | ||
by the Second Injury Fund.
| ||
If the award is not paid within 30 days after the date the | ||
award has
become final, the Commission shall proceed to take | ||
judgment thereon in
its own name as is provided for other | ||
awards by paragraph (g) of Section
19 of this Act and take the | ||
necessary steps to collect the award.
| ||
Any person, corporation or organization who has paid or | ||
become liable
for the payment of burial expenses of the | ||
deceased employee may in his
or its own name institute | ||
proceedings before the Commission for the
collection thereof.
| ||
For the purpose of administration, receipts and | ||
disbursements, the
Special Fund provided for in paragraph (f) | ||
of this Section shall be
administered jointly with the Special | ||
Fund provided for in Section 7,
paragraph (f) of the Workers' | ||
Occupational Diseases Act.
| ||
(g) All compensation, except for burial expenses provided | ||
in this
Section to be paid in case accident results in death, | ||
shall be paid in
installments equal to the percentage of the | ||
average earnings as provided
for in Section 8, paragraph (b) of | ||
this Act, at the same intervals at
which the wages or earnings | ||
of the employees were paid. If this is not
feasible, then the | ||
installments shall be paid weekly. Such compensation
may be | ||
paid in a lump sum upon petition as provided in Section 9 of | ||
this
Act. However, in addition to the benefits provided by |
Section 9 of this
Act where compensation for death is payable | ||
to the deceased's widow,
widower or to the deceased's widow, | ||
widower and one or more children,
and where a partial lump sum | ||
is applied for by such beneficiary or
beneficiaries within 18 | ||
months after the deceased's death, the
Commission may, in its | ||
discretion, grant a partial lump sum of not to
exceed 100 weeks | ||
of the compensation capitalized at their present value
upon the | ||
basis of interest calculated at 3% per annum with annual rests,
| ||
upon a showing that such partial lump sum is for the best | ||
interest of
such beneficiary or beneficiaries.
| ||
(h) In case the injured employee is under 16 years of age | ||
at the
time of the accident and is illegally employed, the | ||
amount of
compensation payable under paragraphs (a), (b), (c), | ||
(d) and (f) of this
Section shall be increased 50%.
| ||
Nothing herein contained repeals or amends the provisions | ||
of the Child
Labor Law relating to the employment of minors | ||
under the age of 16 years.
| ||
However, where an employer has on file an employment | ||
certificate
issued pursuant to the Child Labor Law or work | ||
permit issued pursuant
to the Federal Fair Labor Standards Act, | ||
as amended, or a birth
certificate properly and duly issued, | ||
such certificate, permit or birth
certificate is conclusive | ||
evidence as to the age of the injured minor
employee for the | ||
purposes of this Section only.
| ||
(i) Whenever the dependents of a deceased employee are | ||
aliens not
residing in the United States, Mexico or Canada, the | ||
amount of
compensation payable is limited to the beneficiaries | ||
described in
paragraphs (a), (b) and (c) of this Section and is | ||
50% of the
compensation provided in paragraphs (a), (b) and (c) | ||
of this Section,
except as otherwise provided by treaty.
| ||
In a case where any of the persons who would be entitled to
| ||
compensation is living at any place outside of the United | ||
States, then
payment shall be made to the personal | ||
representative of the deceased
employee. The distribution by | ||
such personal representative to the
persons entitled shall be | ||
made to such persons and in such manner as the
Commission |
orders.
| ||
(Source: P.A. 92-714, eff. 1-1-03; 93-721, eff. 1-1-05.)
| ||
(820 ILCS 305/8) (from Ch. 48, par. 138.8)
| ||
Sec. 8. The amount of compensation which shall be paid to | ||
the
employee for an accidental injury not resulting in death | ||
is:
| ||
(a) The employer shall provide and pay the negotiated rate, | ||
if applicable, or the lesser of the health care provider's | ||
actual charges or according to a fee schedule, subject to | ||
Section 8.2, in effect at the time the service was rendered for | ||
all the necessary first
aid, medical and surgical services, and | ||
all necessary medical, surgical
and hospital services | ||
thereafter incurred, limited, however, to that
which is | ||
reasonably required to cure or relieve from the effects of the
| ||
accidental injury. If the employer does not dispute payment of | ||
first aid, medical, surgical,
and hospital services, the | ||
employer shall make such payment to the provider on behalf of | ||
the employee. The employer shall also pay for treatment,
| ||
instruction and training necessary for the physical, mental and
| ||
vocational rehabilitation of the employee, including all | ||
maintenance
costs and expenses incidental thereto. If as a | ||
result of the injury the
employee is unable to be | ||
self-sufficient the employer shall further pay
for such | ||
maintenance or institutional care as shall be required.
| ||
The employee may at any time elect to secure his own | ||
physician,
surgeon and hospital services at the employer's | ||
expense, or,
| ||
Upon agreement between the employer and the employees, or | ||
the employees'
exclusive representative, and subject to the | ||
approval of the Illinois Workers' Compensation
Commission, the | ||
employer shall maintain a list of physicians, to be
known as a | ||
Panel of Physicians, who are accessible to the employees.
The | ||
employer shall post this list in a place or places easily | ||
accessible
to his employees. The employee shall have the right | ||
to make an
alternative choice of physician from such Panel if |
he is not satisfied
with the physician first selected. If, due | ||
to the nature of the injury
or its occurrence away from the | ||
employer's place of business, the
employee is unable to make a | ||
selection from the Panel, the selection
process from the Panel | ||
shall not apply. The physician selected from the
Panel may | ||
arrange for any consultation, referral or other specialized
| ||
medical services outside the Panel at the employer's expense. | ||
Provided
that, in the event the Commission shall find that a | ||
doctor selected by
the employee is rendering improper or | ||
inadequate care, the Commission
may order the employee to | ||
select another doctor certified or qualified
in the medical | ||
field for which treatment is required. If the employee
refuses | ||
to make such change the Commission may relieve the employer of
| ||
his obligation to pay the doctor's charges from the date of | ||
refusal to
the date of compliance.
| ||
Any vocational rehabilitation counselors who provide | ||
service under this Act shall have
appropriate certifications | ||
which designate the counselor as qualified to render
opinions | ||
relating to vocational rehabilitation. Vocational | ||
rehabilitation
may include, but is not limited to, counseling | ||
for job searches, supervising
a job search program, and | ||
vocational retraining including education at an
accredited | ||
learning institution. The employee or employer may petition to | ||
the Commission to decide disputes relating to vocational | ||
rehabilitation and the Commission shall resolve any such | ||
dispute, including payment of the vocational rehabilitation | ||
program by the employer. | ||
The maintenance benefit shall not be less than the | ||
temporary total disability
rate determined for the employee. In | ||
addition, maintenance shall include costs
and expenses | ||
incidental to the vocational rehabilitation program. | ||
When the employee is working light duty on a part-time | ||
basis or full-time
basis
and earns less than he or she would be | ||
earning if employed in the full capacity
of the job or jobs, | ||
then the employee shall be entitled to temporary partial | ||
disability benefits. Temporary partial disability benefits |
shall be
equal to two-thirds of
the difference between the | ||
average amount that the employee would be able to
earn in the | ||
full performance of his or her duties in the occupation in | ||
which he
or she was engaged at the time of accident and the net | ||
amount which he or she
is
earning in the modified job provided | ||
to the employee by the employer or in any other job that the | ||
employee is working. | ||
Every hospital, physician, surgeon or other person | ||
rendering
treatment or services in accordance with the | ||
provisions of this Section
shall upon written request furnish | ||
full and complete reports thereof to,
and permit their records | ||
to be copied by, the employer, the employee or
his dependents, | ||
as the case may be, or any other party to any proceeding
for | ||
compensation before the Commission, or their attorneys.
| ||
Notwithstanding the foregoing, the employer's liability to | ||
pay for such
medical services selected by the employee shall be | ||
limited to:
| ||
(1) all first aid and emergency treatment; plus
| ||
(2) all medical, surgical and hospital services | ||
provided by the
physician, surgeon or hospital initially | ||
chosen by the employee or by any
other physician, | ||
consultant, expert, institution or other provider of
| ||
services recommended by said initial service provider or | ||
any subsequent
provider of medical services in the chain of | ||
referrals from said
initial service provider; plus
| ||
(3) all medical, surgical and hospital services | ||
provided by any second
physician, surgeon or hospital | ||
subsequently chosen by the employee or by
any other | ||
physician, consultant, expert, institution or other | ||
provider of
services recommended by said second service | ||
provider or any subsequent provider
of medical services in | ||
the chain of referrals
from said second service provider. | ||
Thereafter the employer shall select
and pay for all | ||
necessary medical, surgical and hospital treatment and the
| ||
employee may not select a provider of medical services at | ||
the employer's
expense unless the employer agrees to such |
selection. At any time the employee
may obtain any medical | ||
treatment he desires at his own expense. This paragraph
| ||
shall not affect the duty to pay for rehabilitation | ||
referred to above.
| ||
When an employer and employee so agree in writing, nothing | ||
in this
Act prevents an employee whose injury or disability has | ||
been established
under this Act, from relying in good faith, on | ||
treatment by prayer or
spiritual means alone, in accordance | ||
with the tenets and practice of a
recognized church or | ||
religious denomination, by a duly accredited
practitioner | ||
thereof, and having nursing services appropriate therewith,
| ||
without suffering loss or diminution of the compensation | ||
benefits under
this Act. However, the employee shall submit to | ||
all physical
examinations required by this Act. The cost of | ||
such treatment and
nursing care shall be paid by the employee | ||
unless the employer agrees to
make such payment.
| ||
Where the accidental injury results in the amputation of an | ||
arm,
hand, leg or foot, or the enucleation of an eye, or the | ||
loss of any of
the natural teeth, the employer shall furnish an | ||
artificial of any such
members lost or damaged in accidental | ||
injury arising out of and in the
course of employment, and | ||
shall also furnish the necessary braces in all
proper and | ||
necessary cases. In cases of the loss of a member or members
by | ||
amputation, the employer shall, whenever necessary, maintain | ||
in good
repair, refit or replace the artificial limbs during | ||
the lifetime of the
employee. Where the accidental injury | ||
accompanied by physical injury
results in damage to a denture, | ||
eye glasses or contact eye lenses, or
where the accidental | ||
injury results in damage to an artificial member,
the employer | ||
shall replace or repair such denture, glasses, lenses, or
| ||
artificial member.
| ||
The furnishing by the employer of any such services or | ||
appliances is
not an admission of liability on the part of the | ||
employer to pay
compensation.
| ||
The furnishing of any such services or appliances or the | ||
servicing
thereof by the employer is not the payment of |
compensation.
| ||
(b) If the period of temporary total incapacity for work | ||
lasts more
than 3 working days, weekly compensation as | ||
hereinafter provided shall
be paid beginning on the 4th day of | ||
such temporary total incapacity and
continuing as long as the | ||
total temporary incapacity lasts. In cases
where the temporary | ||
total incapacity for work continues for a period of
14 days or | ||
more from the day of the accident compensation shall commence
| ||
on the day after the accident.
| ||
1. The compensation rate for temporary total | ||
incapacity under this
paragraph (b) of this Section shall | ||
be equal to 66 2/3% of the
employee's average weekly wage | ||
computed in accordance with Section 10,
provided that it | ||
shall be not less than 66 2/3% of the sum of the Federal | ||
minimum wage under the Fair Labor
Standards Act, or the | ||
Illinois minimum wage under the Minimum Wage Law,
whichever | ||
is more, multiplied by 40 hours. This percentage rate shall | ||
be
increased by 10% for each spouse and child, not to | ||
exceed 100% of the total
minimum wage calculation,
the | ||
following amounts in the
following cases:
| ||
$100.90 in case of a single person;
| ||
$105.50 in case of a married person with no | ||
children;
| ||
$108.30 in case of one child;
| ||
$113.40 in case of 2 children;
| ||
$117.40 in case of 3 children;
| ||
$124.30 in case of 4 or more children;
| ||
nor exceed the employee's average weekly wage computed in | ||
accordance
with the provisions of Section 10, whichever is | ||
less.
| ||
2. The compensation rate in all cases other than for | ||
temporary total
disability under this paragraph (b), and | ||
other than for serious and
permanent disfigurement under | ||
paragraph (c) and other than for permanent
partial | ||
disability under subparagraph (2) of paragraph (d) or under
| ||
paragraph (e), of this Section shall be equal to 66
2/3% of |
the employee's average weekly wage computed in accordance | ||
with
the provisions of Section 10, provided that it shall | ||
be not less than
66 2/3% of the sum of the Federal minimum | ||
wage under the Fair Labor Standards Act, or the Illinois | ||
minimum wage under the Minimum Wage Law, whichever is more, | ||
multiplied by 40 hours. This percentage rate shall be | ||
increased by 10% for each spouse and child, not to exceed | ||
100% of the total minimum wage calculation,
the following | ||
amounts in the following cases:
| ||
$80.90 in case of a single person;
| ||
$83.20 in case of a married person with no | ||
children;
| ||
$86.10 in case of one child;
| ||
$88.90 in case of 2 children;
| ||
$91.80 in case of 3 children;
| ||
$96.90 in case of 4 or more children;
| ||
nor exceed the employee's average weekly wage computed in | ||
accordance
with the provisions of Section 10, whichever is | ||
less.
| ||
2.1. The compensation rate in all cases of serious and | ||
permanent
disfigurement under paragraph (c) and of | ||
permanent partial disability
under subparagraph (2) of | ||
paragraph (d) or under paragraph (e) of this
Section shall | ||
be equal to
60% of the employee's average
weekly wage | ||
computed in accordance with
the provisions of Section 10, | ||
provided that it shall be not less than
66 2/3% of the sum | ||
of the Federal minimum wage under the Fair Labor Standards | ||
Act, or the Illinois minimum wage under the Minimum Wage | ||
Law, whichever is more, multiplied by 40 hours. This | ||
percentage rate shall be increased by 10% for each spouse | ||
and child, not to exceed 100% of the total minimum wage | ||
calculation,
the following amounts in the following cases:
| ||
$80.90 in case of a single person;
| ||
$83.20 in case of a married person with no | ||
children;
| ||
$86.10 in case of one child;
|
$88.90 in case of 2 children;
| ||
$91.80 in case of 3 children;
| ||
$96.90 in case of 4 or more children;
| ||
nor exceed the employee's average weekly wage computed in | ||
accordance
with the provisions of Section 10, whichever is | ||
less.
| ||
3. As used in this Section the term "child" means a | ||
child of the
employee including any child legally adopted | ||
before the accident or whom
at the time of the accident the | ||
employee was under legal obligation to
support or to whom | ||
the employee stood in loco parentis, and who at the
time of | ||
the accident was under 18 years of age and not emancipated. | ||
The
term "children" means the plural of "child".
| ||
4. All weekly compensation rates provided under | ||
subparagraphs 1,
2 and 2.1 of this paragraph (b) of this | ||
Section shall be subject to the
following limitations:
| ||
The maximum weekly compensation rate from July 1, 1975, | ||
except as
hereinafter provided, shall be 100% of the | ||
State's average weekly wage in
covered industries under the | ||
Unemployment Insurance Act, that being the
wage that most | ||
closely approximates the State's average weekly wage.
| ||
The maximum weekly compensation rate, for the period | ||
July 1, 1984,
through June 30, 1987, except as hereinafter | ||
provided, shall be $293.61.
Effective July 1, 1987 and on | ||
July 1 of each year thereafter the maximum
weekly | ||
compensation rate, except as hereinafter provided, shall | ||
be
determined as follows: if during the preceding 12 month | ||
period there shall
have been an increase in the State's | ||
average weekly wage in covered
industries under the | ||
Unemployment Insurance Act, the weekly compensation
rate | ||
shall be proportionately increased by the same percentage | ||
as the
percentage of increase in the State's average weekly | ||
wage in covered
industries under the Unemployment | ||
Insurance Act during such period.
| ||
The maximum weekly compensation rate, for the period | ||
January 1, 1981
through December 31, 1983, except as |
hereinafter provided, shall be 100% of
the State's average | ||
weekly wage in covered industries under the
Unemployment | ||
Insurance Act in effect on January 1, 1981. Effective | ||
January
1, 1984 and on January 1, of each year thereafter | ||
the maximum weekly
compensation rate, except as | ||
hereinafter provided, shall be determined as
follows: if | ||
during the preceding 12 month period there shall have been | ||
an
increase in the State's average weekly wage in covered | ||
industries under the
Unemployment Insurance Act, the | ||
weekly compensation rate shall be
proportionately | ||
increased by the same percentage as the percentage of
| ||
increase in the State's average weekly wage in covered | ||
industries under the
Unemployment Insurance Act during | ||
such period.
| ||
From July 1, 1977 and thereafter such maximum weekly | ||
compensation
rate in death cases under Section 7, and | ||
permanent total disability
cases under paragraph (f) or | ||
subparagraph 18 of paragraph (3) of this
Section and for | ||
temporary total disability under paragraph (b) of this
| ||
Section and for amputation of a member or enucleation of an | ||
eye under
paragraph (e) of this Section shall be increased | ||
to 133-1/3% of the
State's average weekly wage in covered | ||
industries under the
Unemployment Insurance Act.
| ||
For injuries occurring on or after February 1, 2006, | ||
the maximum weekly benefit under paragraph (d)1 of this | ||
Section shall be 100% of the State's average weekly wage in | ||
covered industries under the Unemployment Insurance Act.
| ||
4.1. Any provision herein to the contrary | ||
notwithstanding, the
weekly compensation rate for | ||
compensation payments under subparagraph 18
of paragraph | ||
(e) of this Section and under paragraph (f) of this
Section | ||
and under paragraph (a) of Section 7 and for amputation of | ||
a member or enucleation of an eye under paragraph (e) of | ||
this Section , shall in no event be less
than 50% of the | ||
State's average weekly wage in covered industries under
the | ||
Unemployment Insurance Act.
|
4.2. Any provision to the contrary notwithstanding, | ||
the total
compensation payable under Section 7 shall not | ||
exceed the greater of $500,000
$250,000 or 25
20 years.
| ||
5. For the purpose of this Section this State's average | ||
weekly wage
in covered industries under the Unemployment | ||
Insurance Act on
July 1, 1975 is hereby fixed at $228.16 | ||
per
week and the computation of compensation rates shall be | ||
based on the
aforesaid average weekly wage until modified | ||
as hereinafter provided.
| ||
6. The Department of Employment Security of the State | ||
shall
on or before the first day of December, 1977, and on | ||
or before the first
day of June, 1978, and on the first day | ||
of each December and June of each
year thereafter, publish | ||
the State's average weekly wage in covered
industries under | ||
the Unemployment Insurance Act and the Illinois Workers' | ||
Compensation
Commission shall on the 15th day of January, | ||
1978 and on the 15th day of
July, 1978 and on the 15th day | ||
of each January and July of each year
thereafter, post and | ||
publish the State's average weekly wage in covered
| ||
industries under the Unemployment Insurance Act as last | ||
determined and
published by the Department of Employment | ||
Security. The amount when so
posted and published shall be | ||
conclusive and shall be applicable as the
basis of | ||
computation of compensation rates until the next posting | ||
and
publication as aforesaid.
| ||
7. The payment of compensation by an employer or his | ||
insurance
carrier to an injured employee shall not | ||
constitute an admission of the
employer's liability to pay | ||
compensation.
| ||
(c) For any serious and permanent disfigurement to the | ||
hand, head,
face, neck, arm, leg below the knee or the chest | ||
above the axillary
line, the employee is entitled to | ||
compensation for such disfigurement,
the amount determined by | ||
agreement at any time or by arbitration under
this Act, at a | ||
hearing not less than 6 months after the date of the
accidental | ||
injury, which amount shall not exceed 162
150 weeks at the
|
applicable rate provided in subparagraph 2.1 of paragraph (b) | ||
of this Section.
| ||
No compensation is payable under this paragraph where | ||
compensation is
payable under paragraphs (d), (e) or (f) of | ||
this Section.
| ||
A duly appointed member of a fire department in a city, the | ||
population of
which exceeds 200,000 according to the last | ||
federal or State census, is
eligible for compensation under | ||
this paragraph only where such serious and
permanent | ||
disfigurement results from burns.
| ||
(d) 1. If, after the accidental injury has been sustained, | ||
the
employee as a result thereof becomes partially | ||
incapacitated from
pursuing his usual and customary line of | ||
employment, he shall, except in
cases compensated under the | ||
specific schedule set forth in paragraph (e)
of this Section, | ||
receive compensation for the duration of his
disability, | ||
subject to the limitations as to maximum amounts fixed in
| ||
paragraph (b) of this Section, equal to 66-2/3% of the | ||
difference
between the average amount which he would be able to | ||
earn in the full
performance of his duties in the occupation in | ||
which he was engaged at
the time of the accident and the | ||
average amount which he is earning or
is able to earn in some | ||
suitable employment or business after the accident.
| ||
2. If, as a result of the accident, the employee sustains | ||
serious
and permanent injuries not covered by paragraphs (c) | ||
and (e) of this
Section or having sustained injuries covered by | ||
the aforesaid
paragraphs (c) and (e), he shall have sustained | ||
in addition thereto
other injuries which injuries do not | ||
incapacitate him from pursuing the
duties of his employment but | ||
which would disable him from pursuing other
suitable | ||
occupations, or which have otherwise resulted in physical
| ||
impairment; or if such injuries partially incapacitate him from | ||
pursuing
the duties of his usual and customary line of | ||
employment but do not
result in an impairment of earning | ||
capacity, or having resulted in an
impairment of earning | ||
capacity, the employee elects to waive his right
to recover |
under the foregoing subparagraph 1 of paragraph (d) of this
| ||
Section then in any of the foregoing events, he shall receive | ||
in
addition to compensation for temporary total disability | ||
under paragraph
(b) of this Section, compensation at the rate | ||
provided in subparagraph 2.1
of paragraph (b) of this Section | ||
for that percentage of 500 weeks that
the partial disability | ||
resulting from the injuries covered by this
paragraph bears to | ||
total disability. If the employee shall have
sustained a | ||
fracture of one or more vertebra or fracture of the skull,
the | ||
amount of compensation allowed under this Section shall be not | ||
less
than 6 weeks for a fractured skull and 6 weeks for each | ||
fractured
vertebra, and in the event the employee shall have | ||
sustained a fracture
of any of the following facial bones: | ||
nasal, lachrymal, vomer, zygoma,
maxilla, palatine or | ||
mandible, the amount of compensation allowed under
this Section | ||
shall be not less than 2 weeks for each such fractured
bone, | ||
and for a fracture of each transverse process not less than 3
| ||
weeks. In the event such injuries shall result in the loss of a | ||
kidney,
spleen or lung, the amount of compensation allowed | ||
under this Section
shall be not less than 10 weeks for each | ||
such organ. Compensation
awarded under this subparagraph 2 | ||
shall not take into consideration
injuries covered under | ||
paragraphs (c) and (e) of this Section and the
compensation | ||
provided in this paragraph shall not affect the employee's
| ||
right to compensation payable under paragraphs (b), (c) and (e) | ||
of this
Section for the disabilities therein covered.
| ||
(e) For accidental injuries in the following schedule, the | ||
employee
shall receive compensation for the period of temporary | ||
total incapacity
for work resulting from such accidental | ||
injury, under subparagraph 1 of
paragraph (b) of this Section, | ||
and shall receive in addition thereto
compensation for a | ||
further period for the specific loss herein
mentioned, but | ||
shall not receive any compensation under any other
provisions | ||
of this Act. The following listed amounts apply to either
the | ||
loss of or the permanent and complete loss of use of the member
| ||
specified, such compensation for the length of time as follows:
|
1. Thumb- 76
70 weeks.
| ||
2. First, or index finger- 43
40 weeks.
| ||
3. Second, or middle finger- 38
35 weeks.
| ||
4. Third, or ring finger- 27
25 weeks.
| ||
5. Fourth, or little finger- 22
20 weeks.
| ||
6. Great toe- 38
35 weeks.
| ||
7. Each toe other than great toe- 13
12 weeks.
| ||
8. The loss of the first or distal phalanx of the thumb | ||
or of any
finger or toe shall be considered to be equal to | ||
the loss of one-half of
such thumb, finger or toe and the | ||
compensation payable shall be one-half
of the amount above | ||
specified. The loss of more than one phalanx shall
be | ||
considered as the loss of the entire thumb, finger or toe. | ||
In no
case shall the amount received for more than one | ||
finger exceed the
amount provided in this schedule for the | ||
loss of a hand.
| ||
9. Hand- 205
190 weeks. The loss of 2 or more digits, or | ||
one or more
phalanges of 2 or more digits, of a hand may be | ||
compensated on the basis
of partial loss of use of a hand, | ||
provided, further, that the loss of 4
digits, or the loss | ||
of use of 4 digits, in the same hand shall
constitute the | ||
complete loss of a hand.
| ||
10. Arm- 253
235 weeks. Where an accidental injury | ||
results in the
amputation of an arm below the elbow, such | ||
injury shall be compensated
as a loss of an arm. Where an | ||
accidental injury results in the
amputation of an arm above | ||
the elbow, compensation for an additional 17
15
weeks shall | ||
be paid, except where the accidental injury results in the
| ||
amputation of an arm at the shoulder joint, or so close to | ||
shoulder
joint that an artificial arm cannot be used, or | ||
results in the
disarticulation of an arm at the shoulder | ||
joint, in which case
compensation for an additional 70
65 | ||
weeks shall be paid.
| ||
11. Foot- 167
155 weeks.
| ||
12. Leg- 215
200 weeks. Where an accidental injury | ||
results in the
amputation of a leg below the knee, such |
injury shall be compensated as
loss of a leg. Where an | ||
accidental injury results in the amputation of a
leg above | ||
the knee, compensation for an additional 27
25 weeks shall | ||
be
paid, except where the accidental injury results in the | ||
amputation of a
leg at the hip joint, or so close to the | ||
hip joint that an artificial
leg cannot be used, or results | ||
in the disarticulation of a leg at the
hip joint, in which | ||
case compensation for an additional 81
75 weeks shall
be | ||
paid.
| ||
13. Eye- 162
150 weeks. Where an accidental injury | ||
results in the
enucleation of an eye, compensation for an | ||
additional 11
10 weeks shall be
paid.
| ||
14. Loss of hearing of one ear- 54
50 weeks; total and | ||
permanent loss of
hearing of both ears- 215
200 weeks.
| ||
15. Testicle- 54
50 weeks; both testicles- 162
150 | ||
weeks.
| ||
16. For the permanent partial loss of use of a member | ||
or sight of an
eye, or hearing of an ear, compensation | ||
during that proportion of the
number of weeks in the | ||
foregoing schedule provided for the loss of such
member or | ||
sight of an eye, or hearing of an ear, which the partial | ||
loss
of use thereof bears to the total loss of use of such | ||
member, or sight
of eye, or hearing of an ear.
| ||
(a) Loss of hearing for compensation purposes | ||
shall be
confined to the frequencies of 1,000, 2,000 | ||
and 3,000 cycles per second.
Loss of hearing ability | ||
for frequency tones above 3,000 cycles per second
are | ||
not to be considered as constituting disability for | ||
hearing.
| ||
(b) The percent of hearing loss, for purposes of | ||
the
determination of compensation claims for | ||
occupational deafness,
shall be calculated as the | ||
average in decibels for the thresholds
of hearing for | ||
the frequencies of 1,000, 2,000 and 3,000 cycles per | ||
second.
Pure tone air conduction audiometric | ||
instruments, approved by
nationally recognized |
authorities in this field, shall be used for measuring
| ||||||||||||||||
hearing loss. If the losses of hearing average 30 | ||||||||||||||||
decibels or less in the
3 frequencies, such losses of | ||||||||||||||||
hearing shall not then constitute any
compensable | ||||||||||||||||
hearing disability. If the losses of hearing average 85
| ||||||||||||||||
decibels or more in the 3 frequencies, then the same | ||||||||||||||||
shall constitute and
be total or 100% compensable | ||||||||||||||||
hearing loss.
| ||||||||||||||||
(c) In measuring hearing impairment, the lowest | ||||||||||||||||
measured
losses in each of the 3 frequencies shall be | ||||||||||||||||
added together and
divided by 3 to determine the | ||||||||||||||||
average decibel loss. For every decibel
of loss | ||||||||||||||||
exceeding 30 decibels an allowance of 1.82% shall be | ||||||||||||||||
made up to
the maximum of 100% which is reached at 85 | ||||||||||||||||
decibels.
| ||||||||||||||||
(d) If a hearing loss is established to have | ||||||||||||||||
existed on July 1, 1975 by
audiometric testing the | ||||||||||||||||
employer shall not be liable for the previous loss
so | ||||||||||||||||
established nor shall he be liable for any loss for | ||||||||||||||||
which compensation
has been paid or awarded.
| ||||||||||||||||
(e) No consideration shall be given to the question | ||||||||||||||||
of
whether or not the ability of an employee to | ||||||||||||||||
understand speech
is improved by the use of a hearing | ||||||||||||||||
aid.
| ||||||||||||||||
(f) No claim for loss of hearing due to industrial | ||||||||||||||||
noise
shall be brought against an employer or allowed | ||||||||||||||||
unless the employee has
been exposed for a period of | ||||||||||||||||
time sufficient to cause permanent impairment
to noise | ||||||||||||||||
levels in excess of the following:
| ||||||||||||||||
|
| ||||||||||
This subparagraph (f) shall not be applied in cases of | ||||||||||
hearing loss
resulting from trauma or explosion.
| ||||||||||
17. In computing the compensation to be paid to any | ||||||||||
employee who,
before the accident for which he claims | ||||||||||
compensation, had before that
time sustained an injury | ||||||||||
resulting in the loss by amputation or partial
loss by | ||||||||||
amputation of any member, including hand, arm, thumb or | ||||||||||
fingers,
leg, foot or any toes, such loss or partial loss | ||||||||||
of any such member
shall be deducted from any award made | ||||||||||
for the subsequent injury. For
the permanent loss of use or | ||||||||||
the permanent partial loss of use of any
such member or the | ||||||||||
partial loss of sight of an eye, for which
compensation has | ||||||||||
been paid, then such loss shall be taken into
consideration | ||||||||||
and deducted from any award for the subsequent injury.
| ||||||||||
18. The specific case of loss of both hands, both arms, | ||||||||||
or both
feet, or both legs, or both eyes, or of any two | ||||||||||
thereof, or the
permanent and complete loss of the use | ||||||||||
thereof, constitutes total and
permanent disability, to be | ||||||||||
compensated according to the compensation
fixed by | ||||||||||
paragraph (f) of this Section. These specific cases of | ||||||||||
total
and permanent disability do not exclude other cases.
| ||||||||||
Any employee who has previously suffered the loss or | ||||||||||
permanent and
complete loss of the use of any of such | ||||||||||
members, and in a subsequent
independent accident loses | ||||||||||
another or suffers the permanent and complete
loss of the | ||||||||||
use of any one of such members the employer for whom the
| ||||||||||
injured employee is working at the time of the last | ||||||||||
independent accident
is liable to pay compensation only for | ||||||||||
the loss or permanent and
complete loss of the use of the | ||||||||||
member occasioned by the last
independent accident.
| ||||||||||
19. In a case of specific loss and the subsequent death | ||||||||||
of such
injured employee from other causes than such injury |
leaving a widow,
widower, or dependents surviving before | ||
payment or payment in full for
such injury, then the amount | ||
due for such injury is payable to the widow
or widower and, | ||
if there be no widow or widower, then to such
dependents, | ||
in the proportion which such dependency bears to total
| ||
dependency.
| ||
Beginning July 1, 1980, and every 6 months thereafter, the | ||
Commission
shall examine the Second Injury Fund and when, after | ||
deducting all
advances or loans made to such Fund, the amount | ||
therein is $500,000
then the amount required to be paid by | ||
employers pursuant to paragraph
(f) of Section 7 shall be | ||
reduced by one-half. When the Second Injury Fund
reaches the | ||
sum of $600,000 then the payments shall cease entirely.
| ||
However, when the Second Injury Fund has been reduced to | ||
$400,000, payment
of one-half of the amounts required by | ||
paragraph (f) of Section 7
shall be resumed, in the manner | ||
herein provided, and when the Second Injury
Fund has been | ||
reduced to $300,000, payment of the full amounts required by
| ||
paragraph (f) of Section 7 shall be resumed, in the manner | ||
herein provided.
The Commission shall make the changes in | ||
payment effective by
general order, and the changes in payment | ||
become immediately effective
for all cases coming before the | ||
Commission thereafter either by
settlement agreement or final | ||
order, irrespective of the date of the
accidental injury.
| ||
On August 1, 1996 and on February 1 and August 1 of each | ||
subsequent year, the Commission
shall examine the special fund | ||
designated as the "Rate
Adjustment Fund" and when, after | ||
deducting all advances or loans made to
said fund, the amount | ||
therein is $4,000,000, the amount required to be
paid by | ||
employers pursuant to paragraph (f) of Section 7 shall be
| ||
reduced by one-half. When the Rate Adjustment Fund reaches the | ||
sum of
$5,000,000 the payment therein shall cease entirely. | ||
However, when said
Rate Adjustment Fund has been reduced to | ||
$3,000,000 the amounts required by
paragraph (f) of Section 7 | ||
shall be resumed in the manner herein provided.
| ||
(f) In case of complete disability, which renders the |
employee
wholly and permanently incapable of work, or in the | ||
specific case of
total and permanent disability as provided in | ||
subparagraph 18 of
paragraph (e) of this Section, compensation | ||
shall be payable at the rate
provided in subparagraph 2 of | ||
paragraph (b) of this Section for life.
| ||
An employee entitled to benefits under paragraph (f) of | ||
this Section
shall also be entitled to receive from the Rate | ||
Adjustment
Fund provided in paragraph (f) of Section 7 of the | ||
supplementary benefits
provided in paragraph (g) of this | ||
Section 8.
| ||
If any employee who receives an award under this paragraph | ||
afterwards
returns to work or is able to do so, and earns or is | ||
able to earn as
much as before the accident, payments under | ||
such award shall cease. If
such employee returns to work, or is | ||
able to do so, and earns or is able
to earn part but not as much | ||
as before the accident, such award shall be
modified so as to | ||
conform to an award under paragraph (d) of this
Section. If | ||
such award is terminated or reduced under the provisions of
| ||
this paragraph, such employees have the right at any time | ||
within 30
months after the date of such termination or | ||
reduction to file petition
with the Commission for the purpose | ||
of determining whether any
disability exists as a result of the | ||
original accidental injury and the
extent thereof.
| ||
Disability as enumerated in subdivision 18, paragraph (e) | ||
of this
Section is considered complete disability.
| ||
If an employee who had previously incurred loss or the | ||
permanent and
complete loss of use of one member, through the | ||
loss or the permanent
and complete loss of the use of one hand, | ||
one arm, one foot, one leg, or
one eye, incurs permanent and | ||
complete disability through the loss or
the permanent and | ||
complete loss of the use of another member, he shall
receive, | ||
in addition to the compensation payable by the employer and
| ||
after such payments have ceased, an amount from the Second | ||
Injury Fund
provided for in paragraph (f) of Section 7, which, | ||
together with the
compensation payable from the employer in | ||
whose employ he was when the
last accidental injury was |
incurred, will equal the amount payable for
permanent and | ||
complete disability as provided in this paragraph of this
| ||
Section.
| ||
The custodian of the Second Injury Fund provided for in | ||
paragraph (f)
of Section 7 shall be joined with the employer as | ||
a party respondent in
the application for adjustment of claim. | ||
The application for adjustment
of claim shall state briefly and | ||
in general terms the approximate time
and place and manner of | ||
the loss of the first member.
| ||
In its award the Commission or the Arbitrator shall | ||
specifically find
the amount the injured employee shall be | ||
weekly paid, the number of
weeks compensation which shall be | ||
paid by the employer, the date upon
which payments begin out of | ||
the Second Injury Fund provided for in
paragraph (f) of Section | ||
7 of this Act, the length of time the weekly
payments continue, | ||
the date upon which the pension payments commence and
the | ||
monthly amount of the payments. The Commission shall 30 days | ||
after
the date upon which payments out of the Second Injury | ||
Fund have begun as
provided in the award, and every month | ||
thereafter, prepare and submit to
the State Comptroller a | ||
voucher for payment for all compensation accrued
to that date | ||
at the rate fixed by the Commission. The State Comptroller
| ||
shall draw a warrant to the injured employee along with a | ||
receipt to be
executed by the injured employee and returned to | ||
the Commission. The
endorsed warrant and receipt is a full and | ||
complete acquittance to the
Commission for the payment out of | ||
the Second Injury Fund. No other
appropriation or warrant is | ||
necessary for payment out of the Second
Injury Fund. The Second | ||
Injury Fund is appropriated for the purpose of
making payments | ||
according to the terms of the awards.
| ||
As of July 1, 1980 to July 1, 1982, all claims against and | ||
obligations
of the Second Injury Fund shall become claims | ||
against and obligations of
the Rate Adjustment Fund to the | ||
extent there is insufficient money in the
Second Injury Fund to | ||
pay such claims and obligations. In that case, all
references | ||
to "Second Injury Fund" in this Section shall also include the
|
Rate Adjustment Fund.
| ||
(g) Every award for permanent total disability entered by | ||
the
Commission on and after July 1, 1965 under which | ||
compensation payments
shall become due and payable after the | ||
effective date of this amendatory
Act, and every award for | ||
death benefits or permanent total disability
entered by the | ||
Commission on and after the effective date of this
amendatory | ||
Act shall be subject to annual adjustments as to the amount
of | ||
the compensation rate therein provided. Such adjustments shall | ||
first
be made on July 15, 1977, and all awards made and entered | ||
prior to July
1, 1975 and on July 15 of each year
thereafter. | ||
In all other cases such adjustment shall be made on July 15
of | ||
the second year next following the date of the entry of the | ||
award and
shall further be made on July 15 annually thereafter. | ||
If during the
intervening period from the date of the entry of | ||
the award, or the last
periodic adjustment, there shall have | ||
been an increase in the State's
average weekly wage in covered | ||
industries under the Unemployment
Insurance Act, the weekly | ||
compensation rate shall be proportionately
increased by the | ||
same percentage as the percentage of increase in the
State's | ||
average weekly wage in covered industries under the
| ||
Unemployment Insurance Act. The increase in the compensation | ||
rate
under this paragraph shall in no event bring the total | ||
compensation rate
to an amount greater than the prevailing | ||
maximum rate at the time that the annual adjustment is made . | ||
Such increase
shall be paid in the same manner as herein | ||
provided for payments under
the Second Injury Fund to the | ||
injured employee, or his dependents, as
the case may be, out of | ||
the Rate Adjustment Fund provided
in paragraph (f) of Section 7 | ||
of this Act. Payments shall be made at
the same intervals as | ||
provided in the award or, at the option of the
Commission, may | ||
be made in quarterly payment on the 15th day of January,
April, | ||
July and October of each year. In the event of a decrease in
| ||
such average weekly wage there shall be no change in the then | ||
existing
compensation rate. The within paragraph shall not | ||
apply to cases where
there is disputed liability and in which a |
compromise lump sum settlement
between the employer and the | ||
injured employee, or his dependents, as the
case may be, has | ||
been duly approved by the Illinois Workers' Compensation
| ||
Commission.
| ||
Provided, that in cases of awards entered by the Commission | ||
for
injuries occurring before July 1, 1975, the increases in | ||
the
compensation rate adjusted under the foregoing provision of | ||
this
paragraph (g) shall be limited to increases in the State's | ||
average
weekly wage in covered industries under the | ||
Unemployment Insurance Act
occurring after July 1, 1975.
| ||
For every accident occurring after the effective date of | ||
this amendatory Act of the 94th General Assembly, the annual | ||
adjustments to the compensation rate in awards for death | ||
benefits or permanent total disability, as provided in this | ||
Act, shall be paid by the employer. The adjustment shall be | ||
made by the employer on July 15 of the second year next | ||
following the date of the entry of the award and shall further | ||
be made on July 15 annually thereafter. If during the | ||
intervening period from the date of the entry of the award, or | ||
the last periodic adjustment, there shall have been an increase | ||
in the State's average weekly wage in covered industries under | ||
the Unemployment Insurance Act, the employer shall increase the | ||
weekly compensation rate proportionately by the same | ||
percentage as the percentage of increase in the State's average | ||
weekly wage in covered industries under the Unemployment | ||
Insurance Act. The increase in the compensation rate under this | ||
paragraph shall in no event bring the total compensation rate | ||
to an amount greater than the prevailing maximum rate at the | ||
time that the annual adjustment is made. In the event of a | ||
decrease in such average weekly wage there shall be no change | ||
in the then existing compensation rate. Such increase shall be | ||
paid by the employer in the same manner and at the same | ||
intervals as the payment of compensation in the award. This | ||
paragraph shall not apply to cases where there is disputed | ||
liability and in which a compromise lump sum settlement between | ||
the employer and the injured employee, or his or her |
dependents, as the case may be, has been duly approved by the | ||
Illinois Workers' Compensation Commission. | ||
The annual adjustments for every award of death benefits or | ||
permanent total disability involving accidents occurring | ||
before the effective date of this amendatory Act of the 94th | ||
General Assembly shall continue to be paid from the Rate | ||
Adjustment Fund pursuant to this paragraph and Section 7(f) of | ||
this Act.
| ||
(h) In case death occurs from any cause before the total
| ||
compensation to which the employee would have been entitled has | ||
been
paid, then in case the employee leaves any widow, widower, | ||
child, parent
(or any grandchild, grandparent or other lineal | ||
heir or any collateral
heir dependent at the time of the | ||
accident upon the earnings of the
employee to the extent of 50% | ||
or more of total dependency) such
compensation shall be paid to | ||
the beneficiaries of the deceased employee
and distributed as | ||
provided in paragraph (g) of Section 7.
| ||
(h-1) In case an injured employee is under legal disability
| ||
at the time when any right or privilege accrues to him or her | ||
under this
Act, a guardian may be appointed pursuant to law, | ||
and may, on behalf
of such person under legal disability, claim | ||
and exercise any
such right or privilege with the same effect | ||
as if the employee himself
or herself had claimed or exercised | ||
the right or privilege. No limitations
of time provided by this | ||
Act run so long as the employee who is under legal
disability | ||
is without a conservator or guardian.
| ||
(i) In case the injured employee is under 16 years of age | ||
at the
time of the accident and is illegally employed, the | ||
amount of
compensation payable under paragraphs (b), (c), (d), | ||
(e) and (f) of this
Section is increased 50%.
| ||
However, where an employer has on file an employment | ||
certificate
issued pursuant to the Child Labor Law or work | ||
permit issued pursuant
to the Federal Fair Labor Standards Act, | ||
as amended, or a birth
certificate properly and duly issued, | ||
such certificate, permit or birth
certificate is conclusive | ||
evidence as to the age of the injured minor
employee for the |
purposes of this Section.
| ||
Nothing herein contained repeals or amends the provisions | ||
of the
Child Labor Law relating to the employment of minors | ||
under the age of 16 years.
| ||
(j) 1. In the event the injured employee receives benefits,
| ||
including medical, surgical or hospital benefits under any | ||
group plan
covering non-occupational disabilities contributed | ||
to wholly or
partially by the employer, which benefits should | ||
not have been payable
if any rights of recovery existed under | ||
this Act, then such amounts so
paid to the employee from any | ||
such group plan as shall be consistent
with, and limited to, | ||
the provisions of paragraph 2 hereof, shall be
credited to or | ||
against any compensation payment for temporary total
| ||
incapacity for work or any medical, surgical or hospital | ||
benefits made
or to be made under this Act. In such event, the | ||
period of time for
giving notice of accidental injury and | ||
filing application for adjustment
of claim does not commence to | ||
run until the termination of such
payments. This paragraph does | ||
not apply to payments made under any
group plan which would | ||
have been payable irrespective of an accidental
injury under | ||
this Act. Any employer receiving such credit shall keep
such | ||
employee safe and harmless from any and all claims or | ||
liabilities
that may be made against him by reason of having | ||
received such payments
only to the extent of such credit.
| ||
Any excess benefits paid to or on behalf of a State | ||
employee by the
State Employees' Retirement System under | ||
Article 14 of the Illinois Pension
Code on a death claim or | ||
disputed disability claim shall be credited
against any | ||
payments made or to be made by the State of Illinois to or on
| ||
behalf of such employee under this Act, except for payments for | ||
medical
expenses which have already been incurred at the time | ||
of the award. The
State of Illinois shall directly reimburse | ||
the State Employees' Retirement
System to the extent of such | ||
credit.
| ||
2. Nothing contained in this Act shall be construed to give | ||
the
employer or the insurance carrier the right to credit for |
any benefits
or payments received by the employee other than | ||
compensation payments
provided by this Act, and where the | ||
employee receives payments other
than compensation payments, | ||
whether as full or partial salary, group
insurance benefits, | ||
bonuses, annuities or any other payments, the
employer or | ||
insurance carrier shall receive credit for each such payment
| ||
only to the extent of the compensation that would have been | ||
payable
during the period covered by such payment.
| ||
3. The extension of time for the filing of an Application | ||
for
Adjustment of Claim as provided in paragraph 1 above shall | ||
not apply to
those cases where the time for such filing had | ||
expired prior to the date
on which payments or benefits | ||
enumerated herein have been initiated or
resumed. Provided | ||
however that this paragraph 3 shall apply only to
cases wherein | ||
the payments or benefits hereinabove enumerated shall be
| ||
received after July 1, 1969.
| ||
(Source: P.A. 93-721, eff. 1-1-05.)
| ||
(820 ILCS 305/8.2 new)
| ||
Sec. 8.2. Fee schedule.
| ||
(a) Except as provided for in subsection (c), on and after | ||
February 1, 2006, the maximum allowable payment for procedures, | ||
treatments, or services covered under this Act shall be 90% of | ||
the 80th percentile of charges and fees as determined by the | ||
Commission utilizing information provided by employers' and | ||
insurers' national databases, with a minimum of 12,000,000 | ||
Illinois line item charges and fees comprised of health care | ||
provider and hospital charges and fees as of August 1, 2004 but | ||
not earlier than August 1, 2002. These charges and fees are | ||
provider billed amounts and shall not include discounted | ||
charges. The 80th percentile is the point on an ordered data | ||
set from low to high such that 80% of the cases are below or | ||
equal to that point and at most 20% are above or equal to that | ||
point. The Commission shall adjust these historical charges and | ||
fees as of August 1, 2004 by the Consumer Price Index-U for the | ||
period August 1, 2004 through September 30, 2005. The |
Commission shall establish fee schedules for procedures, | ||
treatments, or services for hospital inpatient, hospital | ||
outpatient, emergency room and trauma, ambulatory surgical | ||
treatment centers, and professional services. These charges | ||
and fees shall be designated by geozip or any smaller | ||
geographic unit. The data shall in no way identify or tend to | ||
identify any patient, employer, or health care provider. As | ||
used in this Section, "geozip" means a three-digit zip code | ||
based on data similarities, geographical similarities, and | ||
frequencies. A geozip does not cross state boundaries. As used | ||
in this Section, "three-digit zip code" means a geographic area | ||
in which all zip codes have the same first 3 digits. If a | ||
geozip does not have the necessary number of charges and fees | ||
to calculate a valid percentile for a specific procedure, | ||
treatment, or service, the Commission may combine data from the | ||
geozip with up to 4 other geozips that are demographically and | ||
economically similar and exhibit similarities in data and | ||
frequencies until the Commission reaches 9 charges or fees for | ||
that specific procedure, treatment, or service. In cases where | ||
the compiled data contains less than 9 charges or fees for a | ||
procedure, treatment, or service, reimbursement shall occur at | ||
76% of charges and fees as determined by the Commission in a | ||
manner consistent with the provisions of this paragraph. The | ||
Commission has the authority to set the maximum allowable | ||
payment to providers of out-of-state procedures, treatments, | ||
or services covered under this Act in a manner consistent with | ||
this Section. Not later than September 30 in 2006 and each year | ||
thereafter, the Commission shall automatically increase or | ||
decrease the maximum allowable payment for a procedure, | ||
treatment, or service established and in effect on January 1 of | ||
that year by the percentage change in the Consumer Price | ||
Index-U for the 12 month period ending August 31 of that year. | ||
The increase or decrease shall become effective on January 1 of | ||
the following year. As used in this Section, "Consumer Price | ||
Index-U" means the index published by the Bureau of Labor | ||
Statistics of the U.S. Department of Labor, that measures the |
average change in prices of all goods and services purchased by | ||
all urban consumers, U.S. city average, all items, 1982-84=100. | ||
(b) Notwithstanding the provisions of subsection (a), if
| ||
the Commission finds that there is a significant limitation on
| ||
access to quality health care in either a specific field of
| ||
health care services or a specific geographic limitation on
| ||
access to health care, it may change the Consumer Price Index-U
| ||
increase or decrease for that specific field or specific
| ||
geographic limitation on access to health care to address that
| ||
limitation. | ||
(c) The Commission shall establish by rule a process to | ||
review those medical cases or outliers that involve | ||
extra-ordinary treatment to determine whether to make an | ||
additional adjustment to the maximum payment within a fee | ||
schedule for a procedure, treatment, or service. | ||
(d) When a patient notifies a provider that the treatment, | ||
procedure, or service being sought is for a work-related | ||
illness or injury and furnishes the provider the name and | ||
address of the responsible employer, the provider shall bill | ||
the employer directly. The employer shall make payment and | ||
providers shall submit bills and records in accordance with the | ||
provisions of this Section. All payments to providers for | ||
treatment provided pursuant to this Act shall be made within 60 | ||
days of receipt of the bills as long as the claim contains | ||
substantially all the required data elements necessary to | ||
adjudicate the bills. In the case of nonpayment to a provider | ||
within 60 days of receipt of the bill which contained | ||
substantially all of the required data elements necessary to | ||
adjudicate the bill or nonpayment to a provider of a portion of | ||
such a bill up to the lesser of the actual charge or the | ||
payment level set by the Commission in the fee schedule | ||
established in this Section, the bill, or portion of the bill, | ||
shall incur interest at a rate of 1% per month payable to the | ||
provider. | ||
(e) Except as provided in subsections (e-5), (e-10), and | ||
(e-15), a provider shall not hold an employee liable for costs |
related to a non-disputed procedure, treatment, or service | ||
rendered in connection with a compensable injury. The | ||
provisions of subsections (e-5), (e-10), (e-15), and (e-20) | ||
shall not apply if an employee provides information to the | ||
provider regarding participation in a group health plan. If the | ||
employee participates in a group health plan, the provider may | ||
submit a claim for services to the group health plan. If the | ||
claim for service is covered by the group health plan, the | ||
employee's responsibility shall be limited to applicable | ||
deductibles, co-payments, or co-insurance. Except as provided | ||
under subsections (e-5), (e-10), (e-15), and (e-20), a provider | ||
shall not bill or otherwise attempt to recover from the | ||
employee the difference between the provider's charge and the | ||
amount paid by the employer or the insurer on a compensable | ||
injury. | ||
(e-5) If an employer notifies a provider that the employer | ||
does not consider the illness or injury to be compensable under | ||
this Act, the provider may seek payment of the provider's | ||
actual charges from the employee for any procedure, treatment, | ||
or service rendered. Once an employee informs the provider that | ||
there is an application filed with the Commission to resolve a | ||
dispute over payment of such charges, the provider shall cease | ||
any and all efforts to collect payment for the services that | ||
are the subject of the dispute. Any statute of limitations or | ||
statute of repose applicable to the provider's efforts to | ||
collect payment from the employee shall be tolled from the date | ||
that the employee files the application with the Commission | ||
until the date that the provider is permitted to resume | ||
collection efforts under the provisions of this Section. | ||
(e-10) If an employer notifies a provider that the employer | ||
will pay only a portion of a bill for any procedure, treatment, | ||
or service rendered in connection with a compensable illness or | ||
disease, the provider may seek payment from the employee for | ||
the remainder of the amount of the bill up to the lesser of the | ||
actual charge, negotiated rate, if applicable, or the payment | ||
level set by the Commission in the fee schedule established in |
this Section. Once an employee informs the provider that there | ||
is an application filed with the Commission to resolve a | ||
dispute over payment of such charges, the provider shall cease | ||
any and all efforts to collect payment for the services that | ||
are the subject of the dispute. Any statute of limitations or | ||
statute of repose applicable to the provider's efforts to | ||
collect payment from the employee shall be tolled from the date | ||
that the employee files the application with the Commission | ||
until the date that the provider is permitted to resume | ||
collection efforts under the provisions of this Section. | ||
(e-15) When there is a dispute over the compensability of | ||
or amount of payment for a procedure, treatment, or service, | ||
and a case is pending or proceeding before an Arbitrator or the | ||
Commission, the provider may mail the employee reminders that | ||
the employee will be responsible for payment of any procedure, | ||
treatment or service rendered by the provider. The reminders | ||
must state that they are not bills, to the extent practicable | ||
include itemized information, and state that the employee need | ||
not pay until such time as the provider is permitted to resume | ||
collection efforts under this Section. The reminders shall not | ||
be provided to any credit rating agency. The reminders may | ||
request that the employee furnish the provider with information | ||
about the proceeding under this Act, such as the file number, | ||
names of parties, and status of the case. If an employee fails | ||
to respond to such request for information or fails to furnish | ||
the information requested within 90 days of the date of the | ||
reminder, the provider is entitled to resume any and all | ||
efforts to collect payment from the employee for the services | ||
rendered to the employee and the employee shall be responsible | ||
for payment of any outstanding bills for a procedure, | ||
treatment, or service rendered by a provider. | ||
(e-20) Upon a final award or judgment by an Arbitrator or | ||
the Commission, or a settlement agreed to by the employer and | ||
the employee, a provider may resume any and all efforts to | ||
collect payment from the employee for the services rendered to | ||
the employee and the employee shall be responsible for payment |
of any outstanding bills for a procedure, treatment, or service | ||
rendered by a provider as well as the interest awarded under | ||
subsection (d) of this Section. In the case of a procedure, | ||
treatment, or service deemed compensable, the provider shall | ||
not require a payment rate, excluding the interest provisions | ||
under subsection (d), greater than the lesser of the actual | ||
charge or the payment level set by the Commission in the fee | ||
schedule established in this Section. Payment for services | ||
deemed not covered or not compensable under this Act is the | ||
responsibility of the employee unless a provider and employee | ||
have agreed otherwise in writing. Services not covered or not | ||
compensable under this Act are not subject to the fee schedule | ||
in this Section. | ||
(f) Nothing in this Act shall prohibit an employer or
| ||
insurer from contracting with a health care provider or group
| ||
of health care providers for reimbursement levels for benefits | ||
under this Act different
from those provided in this Section. | ||
(g) On or before January 1, 2010 the Commission shall | ||
provide to the Governor and General Assembly a report regarding | ||
the implementation of the medical fee schedule and the index | ||
used for annual adjustment to that schedule as described in | ||
this Section. | ||
(820 ILCS 305/8.3 new)
| ||
Sec. 8.3. Workers' Compensation Medical Fee Advisory | ||
Board. There is created a Workers' Compensation Medical Fee | ||
Advisory Board consisting of 9 members appointed by the | ||
Governor with the advice and consent of the Senate. Three | ||
members of the Advisory Board shall be representative citizens | ||
chosen from the employee class, 3 members shall be | ||
representative citizens chosen from the employing class, and 3 | ||
members shall be representative citizens chosen from the | ||
medical provider class. Each member shall serve a 4-year term | ||
and shall continue to serve until a successor is appointed. A | ||
vacancy on the Advisory Board shall be filled by the Governor | ||
for the unexpired term. |
Members of the Advisory Board shall receive no compensation | ||
for their services but shall be reimbursed for expenses | ||
incurred in the performance of their duties by the Commission | ||
from appropriations made to the Commission for that purpose. | ||
The Advisory Board shall advise the Commission on | ||
establishment of fees for medical services and accessibility of | ||
medical treatment. | ||
(820 ILCS 305/8.7 new) | ||
Sec. 8.7. Utilization review programs. | ||
(a) As used in this Section: | ||
"Utilization review" means the evaluation of proposed or | ||
provided health care services to determine the appropriateness | ||
of both the level of health care services medically necessary | ||
and the quality of health care services provided to a patient, | ||
including evaluation of their efficiency, efficacy, and | ||
appropriateness of treatment, hospitalization, or office | ||
visits based on medically accepted standards. The evaluation | ||
must be accomplished by means of a system that identifies the | ||
utilization of health care services based on standards of care | ||
or nationally recognized peer review guidelines as well as | ||
nationally recognized evidence based upon standards as | ||
provided in this Act. Utilization techniques may include | ||
prospective review, second opinions, concurrent review, | ||
discharge planning, peer review, independent medical | ||
examinations, and retrospective review. Nothing in this | ||
Section applies to prospective review of necessary first aid or | ||
emergency treatment. | ||
(b) No person may conduct a utilization review program for | ||
workers' compensation services in this State unless once every | ||
2 years the person registers the utilization review program | ||
with the Department of Financial and Professional Regulation | ||
and certifies compliance with the Workers' Compensation | ||
Utilization Management standards or Health Utilization | ||
Management Standards of URAC sufficient to achieve URAC | ||
accreditation or submits evidence of accreditation by URAC for |
its Workers' Compensation Utilization Management Standards or | ||
Health Utilization Management Standards. Nothing in this Act | ||
shall be construed to require an employer or insurer or its | ||
subcontractors to become URAC accredited. | ||
(c) In addition, the Secretary of Financial and | ||
Professional Regulation may certify alternative utilization | ||
review standards of national accreditation organizations or | ||
entities in order for plans to comply with this Section. Any | ||
alternative utilization review standards shall meet or exceed | ||
those standards required under subsection (b). | ||
(d) This registration shall include submission of all of | ||
the following information regarding utilization review program | ||
activities: | ||
(1) The name, address, and telephone number of the | ||
utilization review programs. | ||
(2) The organization and governing structure of the | ||
utilization review programs. | ||
(3) The number of lives for which utilization review is | ||
conducted by each utilization review program. | ||
(4) Hours of operation of each utilization review | ||
program. | ||
(5) Description of the grievance process for each | ||
utilization review program. | ||
(6) Number of covered lives for which utilization | ||
review was conducted for the previous calendar year for | ||
each utilization review program. | ||
(7) Written policies and procedures for protecting | ||
confidential information according to applicable State and | ||
federal laws for each utilization review program. | ||
(e) A utilization review program shall have written | ||
procedures to ensure that patient-specific information | ||
obtained during the process of utilization review will be: | ||
(1) kept confidential in accordance with applicable | ||
State and federal laws; and | ||
(2) shared only with the employee, the employee's | ||
designee, and the employee's health care provider, and |
those who are authorized by law to receive the information. | ||
Summary data shall not be considered confidential if it | ||
does not provide information to allow identification of | ||
individual patients or health care providers. | ||
Only a health care professional may make determinations | ||
regarding the medical necessity of health care services during | ||
the course of utilization review. | ||
When making retrospective reviews, utilization review | ||
programs shall base reviews solely on the medical information | ||
available to the attending physician or ordering provider at | ||
the time the health care services were provided. | ||
(f) If the Department of Financial and Professional | ||
Regulation finds that a utilization review program is not in | ||
compliance with this Section, the Department shall issue a | ||
corrective action plan and allow a reasonable amount of time | ||
for compliance with the plan. If the utilization review program | ||
does not come into compliance, the Department may issue a cease | ||
and desist order. Before issuing a cease and desist order under | ||
this Section, the Department shall provide the utilization | ||
review program with a written notice of the reasons for the | ||
order and allow a reasonable amount of time to supply | ||
additional information demonstrating compliance with the | ||
requirements of this Section and to request a hearing. The | ||
hearing notice shall be sent by certified mail, return receipt | ||
requested, and the hearing shall be conducted in accordance | ||
with the Illinois Administrative Procedure Act. | ||
(g) A utilization review program subject to a corrective | ||
action may continue to conduct business until a final decision | ||
has been issued by the Department. | ||
(h) The Secretary of Financial and Professional Regulation | ||
may by rule establish a registration fee for each person | ||
conducting a utilization review program. | ||
(i) A utilization review will be considered by the | ||
Commission, along with all other evidence and in the same | ||
manner as all other evidence, in the determination of the | ||
reasonableness and necessity of the medical bills or treatment. |
Nothing in this Section shall be construed to diminish the | ||
rights of employees to reasonable and necessary medical | ||
treatment or employee choice of health care provider under | ||
Section 8(a) or the rights of employers to medical examinations | ||
under Section 12. | ||
(j) When an employer denies payment of or refuses to | ||
authorize payment of first aid, medical, surgical, or hospital | ||
services under Section 8(a) of this Act, if that denial or | ||
refusal to authorize complies with a utilization review program | ||
registered under this Section and complies with all other | ||
requirements of this Section, then there shall be a rebuttable | ||
presumption that the employer shall not be responsible for | ||
payment of additional compensation pursuant to Section 19(k) of | ||
this Act and if that denial or refusal to authorize does not | ||
comply with a utilization review program registered under this | ||
Section and does not comply with all other requirements of this | ||
Section, then that will be considered by the Commission, along | ||
with all other evidence and in the same manner as all other | ||
evidence, in the determination of whether the employer may be | ||
responsible for the payment of additional compensation | ||
pursuant to Section 19(k) of this Act.
| ||
(820 ILCS 305/12) (from Ch. 48, par. 138.12)
| ||
Sec. 12. An employee entitled to receive disability | ||
payments shall be
required, if requested by the employer, to | ||
submit himself, at the
expense of the employer, for examination | ||
to a duly qualified medical
practitioner or surgeon selected by | ||
the employer, at any time and place
reasonably convenient for | ||
the employee, either within or without the
State of Illinois, | ||
for the purpose of determining the nature, extent and
probable | ||
duration of the injury received by the employee, and for the
| ||
purpose of ascertaining the amount of compensation which may be | ||
due the
employee from time to time for disability according to | ||
the provisions of
this Act. An employee may also be required to | ||
submit himself for examination
by medical experts under | ||
subsection (c) of Section 19.
|
An employer requesting such an examination, of an employee | ||
residing
within the State of Illinois, shall deliver to the | ||
employee with the notice of the time and place of examination
| ||
pay in advance of the time fixed for
the examination sufficient | ||
money to defray the necessary expense of
travel by the most | ||
convenient means to and from the place of
examination, and the | ||
cost of meals necessary during the trip, and if the
examination | ||
or travel to and from the place of examination causes any
loss | ||
of working time on the part of the employee, the employer shall
| ||
reimburse him for such loss of wages upon the basis of his | ||
average daily
wage. Such examination shall be made in the | ||
presence of a duly qualified
medical practitioner or surgeon | ||
provided and paid for by the employee,
if such employee so | ||
desires.
| ||
In all cases where the examination is made by a surgeon | ||
engaged by
the employer, and the injured employee has no | ||
surgeon present at such
examination, it shall be the duty of | ||
the surgeon making the examination
at the instance of the | ||
employer to deliver to the injured employee, or
his | ||
representative, a statement in writing of the condition and | ||
extent
of the injury to the same extent that said surgeon | ||
reports to the
employer and the same shall be an exact copy of | ||
that furnished to the
employer, said copy to be furnished the | ||
employee, or his representative
as soon as practicable but not | ||
later than 48 hours before the time the
case is set for | ||
hearing. Such delivery shall be made in person either to
the | ||
employee or his representative, or by registered mail to | ||
either, and
the receipt of either shall be proof of such | ||
delivery. If such surgeon
refuses to furnish the employee with | ||
such statement to the same extent
as that furnished the | ||
employer said surgeon shall not be permitted to
testify at the | ||
hearing next following said examination.
| ||
If the employee refuses so to submit himself to examination | ||
or
unnecessarily obstructs the same, his right to compensation | ||
payments
shall be temporarily suspended until such examination | ||
shall have taken
place, and no compensation shall be payable |
under this Act for such
period.
| ||
It shall be the duty of surgeons treating an injured | ||
employee who is
likely to die, and treating him at the instance | ||
of the employer, to have
called in another surgeon to be | ||
designated and paid for by either the
injured employee or by | ||
the person or persons who would become his
beneficiary or | ||
beneficiaries, to make an examination before the death of
such | ||
injured employee.
| ||
In all cases where the examination is made by a surgeon | ||
engaged by
the injured employee, and the employer has no | ||
surgeon present at such
examination, it shall be the duty of | ||
the surgeon making the examination
at the instance of the | ||
employee, to deliver to the employer, or his
representative, a | ||
statement in writing of the condition and extent of
the injury | ||
to the same extent that said surgeon reports to the employee
| ||
and the same shall be an exact copy of that furnished to the | ||
employee,
said copy to be furnished the employer, or his | ||
representative, as soon
as practicable but not later than 48 | ||
hours before the time the case is
set for hearing. Such | ||
delivery shall be made in person either to the
employer, or his | ||
representative, or by registered mail to either, and
the | ||
receipt of either shall be proof of such delivery. If such | ||
surgeon
refuses to furnish the employer with such statement to | ||
the same extent
as that furnished the employee, said surgeon | ||
shall not be permitted to
testify at the hearing next following | ||
said examination.
| ||
(Source: P.A. 81-1482.)
| ||
(820 ILCS 305/13) (from Ch. 48, par. 138.13)
| ||
Sec. 13. There is created an Illinois Workers' Compensation | ||
Commission consisting of 10
7
members to be appointed by the | ||
Governor, by and with the consent of the
Senate, 3
2 of whom | ||
shall be representative citizens of the
employing class | ||
operating under this Act and 3
2 of whom shall
be | ||
representative citizens of the class of employees covered under | ||
this
Act, and 4
3 of whom shall be representative citizens not |
identified
with either the employing or employee classes. Not | ||
more than 6
4 members
of the Commission shall be of the same | ||
political party.
| ||
One of the 3
members not identified with either the | ||
employing or employee classes shall
be designated by the | ||
Governor as Chairman. The Chairman shall be the chief
| ||
administrative and executive officer of the Commission; and he | ||
or she shall
have general supervisory authority over all | ||
personnel of the Commission,
including arbitrators and | ||
Commissioners, and the final authority in all
administrative | ||
matters relating to the Commissioners, including but not
| ||
limited to the assignment and distribution of cases and | ||
assignment of
Commissioners to the panels, except in the | ||
promulgation of procedural rules
and orders under Section 16 | ||
and in the determination of cases under this Act.
| ||
Notwithstanding the general supervisory authority of the | ||
Chairman, each
Commissioner, except those assigned to the | ||
temporary panel, shall have the
authority to hire and supervise | ||
2 staff attorneys each. Such staff attorneys
shall report | ||
directly to the individual Commissioner.
| ||
A formal training program for newly-appointed | ||
Commissioners shall be
implemented. The training program shall | ||
include the following:
| ||
(a) substantive and procedural aspects of the office of | ||
Commissioner;
| ||
(b) current issues in workers' compensation law and | ||
practice;
| ||
(c) medical lectures by specialists in areas such as | ||
orthopedics,
ophthalmology, psychiatry, rehabilitation | ||
counseling;
| ||
(d) orientation to each operational unit of the | ||
Illinois Workers' Compensation Commission;
| ||
(e) observation of experienced arbitrators and | ||
Commissioners conducting
hearings of cases, combined with | ||
the opportunity to discuss evidence
presented and rulings | ||
made;
|
(f) the use of hypothetical cases requiring the | ||
newly-appointed
Commissioner to issue judgments as a means | ||
to evaluating knowledge and
writing ability;
| ||
(g) writing skills.
| ||
A formal and ongoing professional development program | ||
including, but not
limited to, the above-noted areas shall be | ||
implemented to keep
Commissioners informed of recent | ||
developments and issues and to assist them
in maintaining and | ||
enhancing their professional competence.
| ||
The Commissioner candidates, other than the Chairman, must | ||
meet one of
the following qualifications: (a) licensed to | ||
practice law in the State of
Illinois; or (b) served as an | ||
arbitrator at the Illinois Workers' Compensation
Commission | ||
for at least 3 years; or (c) has at least 4 years of
| ||
professional labor relations experience. The Chairman | ||
candidate must have
public or private sector management and | ||
budget experience, as determined
by the Governor.
| ||
Each Commissioner shall devote full time to his duties and | ||
any
Commissioner who is an attorney-at-law shall not engage in | ||
the practice
of law, nor shall any Commissioner hold any other | ||
office or position of
profit under the United States or this | ||
State or any municipal
corporation or political subdivision of | ||
this State, nor engage in any other
business, employment, or | ||
vocation.
| ||
The term of office of each member of the Commission holding | ||
office on
the effective date of this amendatory Act of 1989 is | ||
abolished, but
the incumbents shall continue to exercise all of | ||
the powers and be subject
to all of the duties of Commissioners | ||
until their respective successors are
appointed and qualified.
| ||
The Illinois Workers' Compensation Commission shall | ||
administer this Act.
| ||
In the promulgation of procedural rules, the determination | ||
of cases heard en banc, and other matters determined by the | ||
full Commission, the Chairman's vote shall break a tie in the | ||
event of a tie vote.
| ||
The members shall be appointed by the Governor, with the |
advice and
consent of the Senate, as follows:
| ||
(a) After the effective date of this amendatory Act of | ||
1989, 3
members, at least one of
each political party, and | ||
one of whom shall be a representative citizen
of the | ||
employing class operating under this Act, one of whom shall | ||
be
a representative citizen of the class of employees | ||
covered under this
Act, and one of whom shall be a | ||
representative citizen not identified
with either the | ||
employing or employee classes, shall be appointed
to hold | ||
office until the third Monday in January of 1993, and until | ||
their
successors are appointed and qualified, and 4 | ||
members, one of whom shall be
a representative citizen of | ||
the employing class operating under this Act,
one of whom | ||
shall be a representative citizen of the class of employees
| ||
covered in this Act, and two of whom shall be | ||
representative citizens not
identified with either the | ||
employing or employee classes, one of whom shall
be | ||
designated by the Governor as Chairman (at least one of | ||
each of the two
major political parties) shall be appointed | ||
to hold office until the third
Monday of January in 1991, | ||
and until their successors are appointed and
qualified.
| ||
(a-5) Notwithstanding any other provision of this | ||
Section,
the term of each member of the Commission
who was | ||
appointed by the Governor and is in office on June 30, 2003 | ||
shall
terminate at the close of business on that date or | ||
when all of the successor
members to be appointed pursuant | ||
to this amendatory Act of the 93rd General
Assembly have | ||
been appointed by the Governor, whichever occurs later. As | ||
soon
as possible, the Governor shall appoint persons to | ||
fill the vacancies created
by this amendatory Act. Of the | ||
initial commissioners appointed pursuant to
this | ||
amendatory Act of the 93rd General Assembly, 3 shall be | ||
appointed for
terms ending on the third Monday in January, | ||
2005, and 4 shall be appointed
for terms ending on the | ||
third Monday in January, 2007.
| ||
(a-10) After the effective date of this amendatory Act |
of the 94th General Assembly, the Commission shall be | ||
increased to 10 members. As soon as possible after the | ||
effective date of this amendatory Act of the 94th General | ||
Assembly, the Governor shall appoint, by and with the | ||
consent of the
Senate, the 3 members added to the | ||
Commission under this amendatory Act of the 94th General | ||
Assembly, one of whom shall be a representative citizen of | ||
the employing class operating under this Act, one of whom | ||
shall be a representative of the class of employees covered | ||
under this Act, and one of whom shall be a representative | ||
citizen not identified with either the employing or | ||
employee classes. Of the members appointed under this | ||
amendatory Act of the 94th General Assembly, one shall be | ||
appointed for a term ending on the third Monday in January, | ||
2007, and 2 shall be appointed for terms ending on the | ||
third Monday in January, 2009, and until their successors | ||
are appointed and qualified.
| ||
(b) Members shall thereafter be appointed to hold | ||
office for terms of 4
years from the third Monday in | ||
January of the year of their appointment,
and until their | ||
successors are appointed and qualified. All such
| ||
appointments shall be made so that the composition of the | ||
Commission is in
accordance with the provisions of the | ||
first paragraph of this Section.
| ||
The Chairman shall receive an annual salary of $42,500, or
| ||
a salary set by the Compensation Review Board, whichever is | ||
greater,
and each other member shall receive an annual salary | ||
of $38,000, or a
salary set by the Compensation Review Board, | ||
whichever is greater.
| ||
In case of a vacancy in the office of a Commissioner during | ||
the
recess of the Senate, the Governor shall make a temporary | ||
appointment
until the next meeting of the Senate, when he shall | ||
nominate some person
to fill such office. Any person so | ||
nominated who is confirmed by the
Senate shall hold office | ||
during the remainder of the term and until his
successor is | ||
appointed and qualified.
|
The Illinois Workers' Compensation Commission created by | ||
this amendatory Act of 1989
shall succeed to all the rights, | ||
powers, duties, obligations, records
and other property and | ||
employees of the Industrial Commission which it
replaces as | ||
modified by this amendatory Act of 1989 and all applications
| ||
and reports to actions and proceedings of such prior Industrial | ||
Commission
shall be considered as applications and reports to | ||
actions and proceedings
of the Illinois Workers' Compensation | ||
Commission created by this amendatory Act of 1989.
| ||
Notwithstanding any other provision of this Act, in the | ||
event the
Chairman shall make a finding that a member is or | ||
will be unavailable to
fulfill the responsibilities of his or | ||
her office, the Chairman shall
advise the Governor and the | ||
member in writing and shall designate a
certified arbitrator to | ||
serve as acting Commissioner. The certified
arbitrator shall | ||
act as a Commissioner until the member resumes the duties
of | ||
his or her office or until a new member is appointed by the | ||
Governor, by
and with the consent of the Senate, if a vacancy | ||
occurs in the office of
the Commissioner, but in no event shall | ||
a certified arbitrator serve in the
capacity of Commissioner | ||
for more than 6 months from the date of
appointment by the | ||
Chairman. A finding by the Chairman that a member is or
will be | ||
unavailable to fulfill the responsibilities of his or her | ||
office
shall be based upon notice to the Chairman by a member | ||
that he or she will
be unavailable or facts and circumstances | ||
made known to the Chairman which
lead him to reasonably find | ||
that a member is unavailable to fulfill the
responsibilities of | ||
his or her office. The designation of a certified
arbitrator to | ||
act as a Commissioner shall be considered representative of
| ||
citizens not identified with either the employing or employee | ||
classes and
the arbitrator shall serve regardless of his or her | ||
political affiliation.
A certified arbitrator who serves as an | ||
acting Commissioner shall have all
the rights and powers of a | ||
Commissioner, including salary.
| ||
Notwithstanding any other provision of this Act, the | ||
Governor shall appoint
a special panel of Commissioners |
comprised of 3 members who shall be chosen
by the Governor, by | ||
and with the consent of the Senate, from among the
current | ||
ranks of certified arbitrators. Three members shall hold office
| ||
until the Commission in consultation with the Governor | ||
determines that the
caseload on review has been reduced | ||
sufficiently to allow cases to proceed
in a timely manner or | ||
for a term of 18 months from the effective date of
their | ||
appointment by the Governor, whichever shall be earlier. The 3
| ||
members shall be considered representative of citizens not | ||
identified with
either the employing or employee classes and | ||
shall serve regardless of
political affiliation. Each of the 3 | ||
members shall have only such rights
and powers of a | ||
Commissioner necessary to dispose of those cases assigned
to | ||
the special panel. Each of the 3 members appointed to the | ||
special panel
shall receive the same salary as other | ||
Commissioners for the duration of
the panel.
| ||
The Commission may have an Executive Director; if so, the | ||
Executive
Director shall be appointed by the Governor with the | ||
advice and consent of the
Senate. The salary and duties of the | ||
Executive Director shall be fixed by the
Commission.
| ||
On the effective date of this amendatory Act of
the 93rd | ||
General Assembly, the name of the Industrial Commission is | ||
changed to the Illinois Workers' Compensation Commission. | ||
References in any law, appropriation, rule, form, or other
| ||
document: (i) to the Industrial Commission
are deemed, in | ||
appropriate contexts, to be references to the Illinois Workers' | ||
Compensation Commission for all purposes; (ii) to the | ||
Industrial Commission Operations Fund
are deemed, in | ||
appropriate contexts, to be references to the Illinois Workers' | ||
Compensation Commission Operations Fund for all purposes; | ||
(iii) to the Industrial Commission Operations Fund Fee are | ||
deemed, in appropriate contexts, to be
references to the | ||
Illinois Workers' Compensation Commission Operations Fund Fee | ||
for all
purposes; and (iv) to the Industrial Commission | ||
Operations Fund Surcharge are deemed, in appropriate contexts, | ||
to be
references to the Illinois Workers' Compensation |
Commission Operations Fund Surcharge for all
purposes. | ||
(Source: P.A. 93-509, eff. 8-11-03; 93-721, eff. 1-1-05.)
| ||
(820 ILCS 305/13.1) (from Ch. 48, par. 138.13-1)
| ||
Sec. 13.1. (a) There is created a Workers' Compensation | ||
Advisory Board
hereinafter referred to as the Advisory Board . | ||
After the effective date of this amendatory Act of the 94th | ||
General Assembly, the Advisory Board shall consist , consisting | ||
of 12
9 members
appointed by the Governor with the advice and | ||
consent of the Senate. Six
Three
members of the Advisory Board | ||
shall be
representative citizens chosen from the employee | ||
class, and 6
3 members shall be
representative citizens chosen | ||
from the employing class and 3 members shall
be representative | ||
citizens not identified with either the employing or
employee | ||
class . The Chairman of the Commission shall serve as the ex | ||
officio Chairman of the Advisory Board. After the effective | ||
date of this amendatory Act of the 94th General Assembly, each | ||
member of the Advisory Board shall serve a 4 year
term ending | ||
on the third Monday in January 2007 and shall continue to serve | ||
until his or her successor is appointed and qualified. Members | ||
of the Advisory Board shall thereafter be appointed for 4 year | ||
terms from the third Monday in January of the year of their | ||
appointment, and until their successors are appointed and | ||
qualified . The Governor shall select one of the members not | ||
identified with
either the employing or employee class to serve | ||
as Chairman.
Seven
Five members
of the Advisory Board shall | ||
constitute a quorum to do business, but in no
case shall there | ||
be less than one representative from each class , employee,
| ||
employing and representative citizen not identified with | ||
either the
employing or employee class . A vacancy on the | ||
Advisory Board shall be
filled by the Governor for the | ||
unexpired term.
| ||
(b) Members of the Advisory Board shall receive no | ||
compensation for
their services but shall be reimbursed for | ||
expenses incurred in the
performance of their duties by the | ||
Commission from appropriations made to
the Commission for such |
purpose.
| ||
(c) The Advisory Board shall aid the Commission in | ||
formulating policies,
discussing problems, setting priorities | ||
of expenditures and establishing
short and long range | ||
administrative goals. Prior to making appointments to the | ||
Commission, the Governor shall request that the Advisory Board | ||
make recommendations as to candidates to consider for | ||
appointment and the Advisory Board may then make such | ||
recommendations.
| ||
(Source: P.A. 86-998.)
| ||
(820 ILCS 305/14) (from Ch. 48, par. 138.14)
| ||
Sec. 14. The Commission shall appoint a secretary, an | ||
assistant
secretary, and arbitrators and shall employ such
| ||
assistants and clerical help as may be necessary.
| ||
Each arbitrator appointed after November 22, 1977 shall be | ||
required
to demonstrate in writing and in accordance with
the | ||
rules and regulations of the Illinois Department of Central | ||
Management
Services his or
her knowledge of and expertise in | ||
the law of and judicial processes of
the Workers' Compensation | ||
Act and the Occupational Diseases Act.
| ||
A formal training program for newly-hired arbitrators | ||
shall be
implemented. The training program shall include the | ||
following:
| ||
(a) substantive and procedural aspects of the | ||
arbitrator position;
| ||
(b) current issues in workers' compensation law and | ||
practice;
| ||
(c) medical lectures by specialists in areas such as | ||
orthopedics,
ophthalmology, psychiatry, rehabilitation | ||
counseling;
| ||
(d) orientation to each operational unit of the | ||
Illinois Workers' Compensation Commission;
| ||
(e) observation of experienced arbitrators conducting | ||
hearings of cases,
combined with the opportunity to discuss | ||
evidence presented and rulings made;
|
(f) the use of hypothetical cases requiring the trainee | ||
to issue
judgments as a means to evaluating knowledge and | ||
writing ability;
| ||
(g) writing skills.
| ||
A formal and ongoing professional development program | ||
including, but not
limited to, the above-noted areas shall be | ||
implemented to keep arbitrators
informed of recent | ||
developments and issues and to assist them in
maintaining and | ||
enhancing their professional competence.
| ||
Each
arbitrator shall devote full time to his or her duties | ||
and shall serve when
assigned as
an acting Commissioner when a | ||
Commissioner is unavailable in accordance
with the provisions | ||
of Section 13 of this Act. Any
arbitrator who is an | ||
attorney-at-law shall not engage in the practice of
law, nor | ||
shall any arbitrator hold any other office or position of
| ||
profit under the United States or this State or any municipal
| ||
corporation or political subdivision of this State.
| ||
Notwithstanding any other provision of this Act to the | ||
contrary, an arbitrator
who serves as an acting Commissioner in | ||
accordance with the provisions of
Section 13 of this Act shall | ||
continue to serve in the capacity of Commissioner
until a | ||
decision is reached in every case heard by that arbitrator | ||
while
serving as an acting Commissioner.
| ||
Each arbitrator appointed after the effective date of this | ||
amendatory
Act of 1989 shall be appointed for a term of 6 | ||
years. Each arbitrator
shall be appointed for a subsequent term | ||
unless the Chairman makes a
recommendation to the Commission, | ||
no later than 60 days prior to the
expiration of the term, not | ||
to reappoint the arbitrator. Notice of such a
recommendation | ||
shall also be given to the arbitrator no later than 60 days
| ||
prior to the expiration of the term. Upon
such recommendation | ||
by the Chairman, the arbitrator shall be appointed for
a | ||
subsequent term unless 8
5 of 10
7 members of the Commission, | ||
including the
Chairman, vote not to reappoint the arbitrator.
| ||
All arbitrators shall be subject to the provisions of the | ||
Personnel Code,
and the performance of all arbitrators shall be |
reviewed by the Chairman on
an annual basis. The Chairman shall | ||
allow input from the Commissioners in
all such reviews.
| ||
The Secretary and each arbitrator shall receive a per annum | ||
salary of
$4,000 less than the per annum salary of members of | ||
The
Illinois Workers' Compensation Commission as
provided in | ||
Section 13 of this Act, payable in equal monthly installments.
| ||
The members of the Commission, Arbitrators and other | ||
employees whose
duties require them to travel, shall have | ||
reimbursed to them their
actual traveling expenses and | ||
disbursements made or incurred by them in
the discharge of | ||
their official duties while away from their place of
residence | ||
in the performance of their duties.
| ||
The Commission shall provide itself with a seal for the
| ||
authentication of its orders, awards and proceedings upon which | ||
shall be
inscribed the name of the Commission and the words | ||
"Illinois--Seal".
| ||
The Secretary or Assistant Secretary, under the direction | ||
of the
Commission, shall have charge and custody of the seal of | ||
the Commission
and also have charge and custody of all records, | ||
files, orders,
proceedings, decisions, awards and other | ||
documents on file with the
Commission. He shall furnish | ||
certified copies, under the seal of the
Commission, of any such | ||
records, files, orders, proceedings, decisions,
awards and | ||
other documents on file with the Commission as may be
required. | ||
Certified copies so furnished by the Secretary or Assistant
| ||
Secretary shall be received in evidence before the Commission | ||
or any
Arbitrator thereof, and in all courts, provided that the | ||
original of
such certified copy is otherwise competent and | ||
admissible in evidence.
The Secretary or Assistant Secretary | ||
shall perform such other duties as
may be prescribed from time | ||
to time by the Commission.
| ||
(Source: P.A. 93-721, eff. 1-1-05.)
| ||
(820 ILCS 305/16) (from Ch. 48, par. 138.16)
| ||
Sec. 16. The Commission shall make and publish procedural | ||
rules and
orders for carrying out the duties imposed upon it by |
law and for
determining the extent of disability sustained, | ||
which rules and orders
shall be deemed prima facie reasonable | ||
and valid.
| ||
The process and procedure before the Commission shall be as | ||
simple
and summary as reasonably may be.
| ||
The Commission upon application of either party may issue | ||
dedimus
potestatem directed to a commissioner, notary public, | ||
justice of the
peace or any other officer authorized by law to | ||
administer oaths, to
take the depositions of such witness or | ||
witnesses as may be necessary in
the judgment of such | ||
applicant. Such dedimus potestatem may issue to
any of the | ||
officers aforesaid in any state or territory of the United
| ||
States. When the deposition of any witness resident of a | ||
foreign
country is desired to be taken, the dedimus shall be | ||
directed to and the
deposition taken before a consul, vice | ||
consul or other authorized
representative of the government of | ||
the United States of America, whose
station is in the country | ||
where the witness whose deposition is to be
taken resides. In | ||
countries where the government of the United States
has no | ||
consul or other diplomatic representative, then depositions in
| ||
such case shall be taken through the appropriate judicial | ||
authority of
that country; or where treaties provide for other | ||
methods of taking
depositions, then the same may be taken as in | ||
such treaties provided.
The Commission shall have the power to | ||
adopt necessary rules to govern
the issue of such dedimus | ||
potestatem.
| ||
The Commission, or any member thereof, or any Arbitrator | ||
designated
by the Commission shall have the power to administer | ||
oaths, subpoena
and examine witnesses; to issue subpoenas duces | ||
tecum, requiring the
production of such books, papers, records | ||
and documents as may be
evidence of any matter under inquiry | ||
and to examine and inspect the same
and such places or premises | ||
as may relate to the question in dispute.
The Commission, or | ||
any member thereof, or any Arbitrator designated by
the | ||
Commission, shall on written request of either party to the
| ||
dispute, issue subpoenas for the attendance of such witnesses |
and
production of such books, papers, records and documents as | ||
shall be
designated in the applications, and the parties
| ||
applying for such subpoena shall advance the officer and | ||
witness fees
provided for in civil actions pending in circuit | ||
courts of this State, except
as otherwise
provided by Section | ||
20 of this Act. Service of such subpoena shall be
made by any | ||
sheriff or other person. In case any person
refuses to comply | ||
with an order of the Commission or subpoenas issued by
it or by | ||
any member thereof, or any Arbitrator designated by the
| ||
Commission or to permit an inspection of places or premises, or | ||
to
produce any books, papers, records or documents, or any | ||
witness refuses
to testify to any matters regarding which he or | ||
she may be lawfully
interrogated, the Circuit Court of the | ||
county in which the hearing or
matter is pending, on | ||
application of any member of the Commission or any
Arbitrator | ||
designated by the Commission, shall compel obedience by
| ||
attachment proceedings, as for contempt, as in a case of | ||
disobedience of
the requirements of a subpoena from such court | ||
on a refusal to testify
therein.
| ||
The records , reports, and bills kept by a treating | ||
hospital , treating physician, or other treating healthcare | ||
provider that renders treatment to the employee as a result of | ||
accidental injuries in question , certified to as true and | ||
correct by
the hospital, physician, or other healthcare | ||
provider or by designated agents of the hospital, physician, or | ||
other healthcare provider,
superintendent or other officer in | ||
charge, showing the medical and
surgical treatment given an | ||
injured employee by
in such hospital, physician, or other | ||
healthcare provider, shall be
admissible without any further | ||
proof as evidence of the medical and
surgical matters stated | ||
therein, but shall not be conclusive proof of
such matters. | ||
There shall be a rebuttable presumption that any such records, | ||
reports, and bills received in response to Commission subpoena | ||
are certified to be true and correct. This paragraph does not | ||
restrict, limit, or prevent the admissibility of records, | ||
reports, or bills that are otherwise admissible. This provision |
does not apply to reports prepared by treating providers for | ||
use in litigation.
| ||
The Commission at its expense shall provide an official | ||
court
reporter to take the testimony and record of proceedings | ||
at the hearings
before an Arbitrator or the Commission, who
| ||
shall furnish a transcript of such testimony or proceedings to | ||
either
party requesting it, upon payment therefor at the rate | ||
of $1.00
per page for the original and 35 cents per page for | ||
each copy of such
transcript. Payment for photostatic copies of | ||
exhibits shall be extra.
If the Commission has determined, as | ||
provided in Section 20
of this Act, that the employee is a poor | ||
person, a transcript of such
testimony and proceedings, | ||
including photostatic copies of exhibits,
shall be furnished to | ||
such employee at the
Commission's expense.
| ||
The Commission shall have the power to determine the | ||
reasonableness
and fix the amount of any fee of compensation | ||
charged by any person,
including attorneys, physicians, | ||
surgeons and hospitals, for any service
performed in connection | ||
with this Act, or for which payment is to be
made under this | ||
Act or rendered in securing any right under this Act.
| ||
Whenever the Commission shall find that the employer, his | ||
or her agent,
service company or insurance carrier has been | ||
guilty of delay or
unfairness towards an employee in the | ||
adjustment, settlement or payment
of benefits due such employee | ||
within the purview of the provisions of
paragraph (c) of | ||
Section 4 of this Act; or has been guilty of
unreasonable or | ||
vexatious delay, intentional under-payment of
compensation | ||
benefits, or has engaged in frivolous defenses which do not
| ||
present a real controversy, within the purview of the | ||
provisions of
paragraph (k) of Section 19 of this Act, the | ||
Commission may assess all
or any part of the attorney's fees | ||
and costs against such employer and
his or her insurance | ||
carrier.
| ||
(Source: P.A. 86-998.)
| ||
(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
| ||
Beginning January 1, 1981 , 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
5 members of the Commission that
such | ||
argument be held before all available members of the | ||
Commission)
pursuant to the rules and regulations of the | ||
Commission. A panel of 3
members, which shall be comprised of | ||
not more than one representative
citizen of the employing class | ||
and not more than one representative citizen
of the employee | ||
class, shall hear the argument; provided that if all the
issues | ||
in dispute are solely the nature and extent of the permanent | ||
partial
disability, if any, a majority of the panel may deny | ||
the request for such
argument and such argument shall not be | ||
held; and provided further that 7
5
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, 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 pay
to the | ||
Commission the sum of 80¢ per page of testimony taken | ||
before the
Commission, and 35¢ per page of all other | ||
matters contained in such
record, except as otherwise | ||
provided by Section 20 of this Act. Payment
for photostatic | ||
copies of exhibit shall be extra. It shall be the duty
of | ||
the Commission upon such payment, or failure to pay as | ||
permitted
under Section 20 of this Act, to prepare a true | ||
and correct typewritten
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.
| ||
In its decision on review the Commission shall | ||
determine in each
particular case the amount of the | ||
probable cost of the record to be
filed as a part of the | ||
summons in that case and 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 payment by filing a | ||
receipt showing payment or an affidavit
of the attorney | ||
setting forth that payment has been made of the sums so
| ||
determined to the Secretary or Assistant Secretary of the | ||
Commission,
except as otherwise provided by Section 20 of | ||
this Act.
| ||
(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.
| ||
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.
| ||
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 60 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.
In case the employer or his | ||
insurance carrier shall without good
and just cause fail, | ||
neglect, refuse or unreasonably delay the payment
of weekly | ||
compensation benefits due to an injured employee during the
|
period of temporary total disability the arbitrator or the | ||
Commission
shall allow to the employee additional compensation | ||
in the sum of $10
per day for each day that a weekly | ||
compensation payment has been so
withheld or refused, provided | ||
that such additional compensation shall
not exceed the sum of | ||
$2,500. 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 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. 93-721, eff. 1-1-05.)
| ||
(820 ILCS 305/25.5 new)
| ||
Sec. 25.5. Unlawful acts; penalties. | ||
(a) It is unlawful for any person, company, corporation, | ||
insurance carrier, healthcare provider, or other entity to: | ||
(1) Intentionally present or cause to be presented any | ||
false or
fraudulent claim for the payment of any workers' |
compensation
benefit.
| ||
(2) Intentionally make or cause to be made any false or
| ||
fraudulent material statement or material representation | ||
for the
purpose of obtaining or denying any workers' | ||
compensation
benefit.
| ||
(3) Intentionally make or cause to be made any false or
| ||
fraudulent statements with regard to entitlement to | ||
workers'
compensation benefits with the intent to prevent | ||
an injured
worker from making a legitimate claim for any | ||
workers'
compensation benefits.
| ||
(4) Intentionally prepare or provide an invalid, | ||
false, or
counterfeit certificate of insurance as proof of | ||
workers'
compensation insurance.
| ||
(5) Intentionally make or cause to be made any false or
| ||
fraudulent material statement or material representation | ||
for the
purpose of obtaining workers' compensation | ||
insurance at less
than the proper rate for that insurance.
| ||
(6) Intentionally make or cause to be made any false or
| ||
fraudulent material statement or material representation | ||
on an
initial or renewal self-insurance application or | ||
accompanying
financial statement for the purpose of | ||
obtaining self-insurance
status or reducing the amount of | ||
security that may be required
to be furnished pursuant to | ||
Section 4 of this Act.
| ||
(7) Intentionally make or cause to be made any false or
| ||
fraudulent material statement to the Division of | ||
Insurance's
fraud and insurance non-compliance unit in the | ||
course of an
investigation of fraud or insurance | ||
non-compliance.
| ||
(8) Intentionally assist, abet, solicit, or conspire | ||
with any
person, company, or other entity to commit any of | ||
the acts in
paragraph (1), (2), (3), (4), (5), (6), or (7) | ||
of this subsection (a).
| ||
For the purposes of paragraphs (2), (3), (5), (6), and (7), | ||
the term "statement" includes any writing, notice, proof of | ||
injury, bill for services, hospital or doctor records and |
reports, or X-ray and test results.
| ||
(b) Any person violating subsection (a) is guilty of a | ||
Class 4 felony. Any person or entity convicted of any violation | ||
of this Section shall be ordered to pay complete restitution to | ||
any person or entity so defrauded in addition to any fine or | ||
sentence imposed as a result of the conviction.
| ||
(c) The Division of Insurance of the Department of | ||
Financial and Professional Regulation shall establish a fraud | ||
and insurance non-compliance unit responsible for | ||
investigating incidences of fraud and insurance non-compliance | ||
pursuant to this Section. The size of the staff of the unit | ||
shall be subject to appropriation by the General Assembly. It | ||
shall be the duty of the fraud and insurance non-compliance | ||
unit to determine the identity of insurance carriers, | ||
employers, employees, or other persons or entities who have | ||
violated the fraud and insurance non-compliance provisions of | ||
this Section. The fraud and insurance non-compliance unit shall | ||
report violations of the fraud and insurance non-compliance | ||
provisions of this Section to the Attorney General or to the | ||
State's Attorney of the county in which the offense allegedly | ||
occurred, either of whom has the authority to prosecute | ||
violations under this Section.
| ||
With respect to the subject of any investigation being | ||
conducted, the fraud and insurance non-compliance unit shall | ||
have the general power of subpoena of the Division of | ||
Insurance.
| ||
(d) Any person may report allegations of insurance | ||
non-compliance and fraud pursuant to this Section to the | ||
Division of Insurance's fraud and insurance non-compliance | ||
unit whose duty it shall be to investigate the report. The unit | ||
shall notify the Commission of reports of insurance | ||
non-compliance. Any person reporting an allegation of | ||
insurance non-compliance or fraud against either an employee or | ||
employer under this Section must identify himself. Except as | ||
provided in this subsection and in subsection (e), all reports | ||
shall remain confidential except to refer an investigation to |
the Attorney General or State's Attorney for prosecution or if | ||
the fraud and insurance non-compliance unit's investigation | ||
reveals that the conduct reported may be in violation of other | ||
laws or regulations of the State of Illinois, the unit may | ||
report such conduct to the appropriate governmental agency | ||
charged with administering such laws and regulations. Any | ||
person who intentionally makes a false report under this | ||
Section to the fraud and insurance non-compliance unit is | ||
guilty of a Class A misdemeanor.
| ||
(e) In order for the fraud and insurance non-compliance | ||
unit to investigate a report of fraud by an employee, (i) the | ||
employee must have filed with the Commission an Application for | ||
Adjustment of Claim and the employee must have either received | ||
or attempted to receive benefits under this Act that are | ||
related to the reported fraud or (ii) the employee must have | ||
made a written demand for the payment of benefits that are | ||
related to the reported fraud. Upon receipt of a report of | ||
fraud, the employee or employer shall receive immediate notice | ||
of the reported conduct, including the verified name and | ||
address of the complainant if that complainant is connected to | ||
the case and the nature of the reported conduct. The fraud and | ||
insurance non-compliance unit shall resolve all reports of | ||
fraud against employees or employers within 120 days of receipt | ||
of the report. There shall be no immunity, under this Act or | ||
otherwise, for any person who files a false report or who files | ||
a report without good and just cause. Confidentiality of | ||
medical information shall be strictly maintained. | ||
Investigations that are not referred for prosecution shall be | ||
immediately expunged and shall not be disclosed except that the | ||
employee or employer who was the subject of the report and the | ||
person making the report shall be notified that the | ||
investigation is being closed, at which time the name of any | ||
complainant not connected to the case shall be disclosed to the | ||
employee or the employer. It is unlawful for any employer, | ||
insurance carrier, or service adjustment company to file or | ||
threaten to file a report of fraud against an employee because |
of the exercise by the employee of the rights and remedies | ||
granted to the employee by this Act.
| ||
For purposes of this subsection (e), "employer" means any | ||
employer, insurance carrier, third party administrator, | ||
self-insured, or similar entity.
| ||
For purposes of this subsection (e), "complainant" refers | ||
to the person contacting the fraud and insurance non-compliance | ||
unit to initiate the complaint.
| ||
(f) Any person convicted of fraud related to workers' | ||
compensation pursuant to this Section shall be subject to the | ||
penalties prescribed in the Criminal Code of 1961 and shall be | ||
ineligible to receive or retain any compensation, disability, | ||
or medical benefits as defined in this Act if the compensation, | ||
disability, or medical benefits were owed or received as a | ||
result of fraud for which the recipient of the compensation, | ||
disability, or medical benefit was convicted. This subsection | ||
applies to accidental injuries or diseases that occur on or | ||
after the effective date of this amendatory Act of the 94th | ||
General Assembly.
| ||
(g) Civil liability. Any person convicted of fraud who | ||
knowingly obtains, attempts to obtain, or causes to be obtained | ||
any benefits under this Act by the making of a false claim or | ||
who knowingly misrepresents any material fact shall be civilly | ||
liable to the payor of benefits or the insurer or the payor's | ||
or insurer's subrogee or assignee in an amount equal to 3 times | ||
the value of the benefits or insurance coverage wrongfully | ||
obtained or twice the value of the benefits or insurance | ||
coverage attempted to be obtained, plus reasonable attorney's | ||
fees and expenses incurred by the payor or the payor's subrogee | ||
or assignee who successfully brings a claim under this | ||
subsection. This subsection applies to accidental injuries or | ||
diseases that occur on or after the effective date of this | ||
amendatory Act of the 94th General Assembly.
| ||
(h) All proceedings under this Section shall be reported by | ||
the fraud and insurance non-compliance unit on an annual basis | ||
to the Workers' Compensation Advisory Board.
|
Section 15. The Workers' Occupational Diseases Act is | ||
amended by changing Sections 12 and 19 as follows:
| ||
(820 ILCS 310/12) (from Ch. 48, par. 172.47)
| ||
Sec. 12. (a) An employee entitled to receive disability | ||
payments
shall be required, if requested by the employer, to | ||
submit himself, at
the expense of the employer, for examination | ||
to a duly qualified medical
practitioner or surgeon selected by | ||
the employer, at any time and place
reasonably convenient for | ||
the employee, either within or without the
State of Illinois, | ||
for the purpose of determining the nature, extent and
probable | ||
duration of the occupational disease and the disability
| ||
therefrom suffered by the employee, and for the purpose of | ||
ascertaining
the amount of compensation which may be due the | ||
employee from time to
time for disability according to the | ||
provisions of this Act. An employee
may also be required to | ||
submit himself for examination by medical experts
under | ||
subsection (c) of Section 19.
| ||
An employer requesting such an examination, of an employee | ||
residing
within the State of Illinois, shall deliver to the | ||
employee with the notice of the time and place of examination
| ||
pay in advance of the time fixed for
the examination sufficient | ||
money to defray the necessary expense of
travel by the most | ||
convenient means to and from the place of
examination, and the | ||
cost of meals necessary during the trip, and if the
examination | ||
or travel to and from the place of examination causes any
loss | ||
of working time on the part of the employee, the employer shall
| ||
reimburse him for such loss of wages upon the basis of his | ||
average daily
wage. Such examination shall be made in the | ||
presence of a duly qualified
medical practitioner or surgeon | ||
provided and paid for by the employee,
if such employee so | ||
desires.
| ||
In all cases where the examination is made by a physician | ||
or surgeon
engaged by the employer, and the employee has no | ||
physician or surgeon
present at such examination, it shall be |
the duty of the physician or
surgeon making the examination at | ||
the instance of the employer to
deliver to the employee, or his | ||
representative, a statement in writing
of the examination and | ||
findings to the same extent that said physician
or surgeon | ||
reports to the employer and the same shall be an exact copy
of | ||
that furnished to the employer, said copy to be furnished the
| ||
employee, or his representative as soon as practicable but not | ||
later
than the time the case is set for hearing. Such delivery | ||
shall be made
in person either to the employee or his | ||
representative, or by registered
mail to either, and the | ||
receipt of either shall be proof of such
delivery. If such | ||
physician or surgeon refuses to furnish the employee
with such | ||
statement to the same extent as that furnished the employer
| ||
said physician or surgeon shall not be permitted to testify at | ||
the
hearing next following said examination.
| ||
If the employee refuses so to submit himself to examination | ||
or
unnecessarily obstructs the same, his right to compensation | ||
payment
shall be temporarily suspended until such examination | ||
shall have taken
place, and no compensation shall be payable | ||
under this Act for such
period.
| ||
It shall be the duty of physicians or surgeons treating an | ||
employee
who is likely to die, and treating him at the instance | ||
of the employer,
to have called in another physician or surgeon | ||
to be designated and paid
for by either the employee or by the | ||
person or persons who would become
his beneficiary or | ||
beneficiaries, to make an examination before the
death of such | ||
employee.
| ||
In all cases where the examination is made by a physician | ||
or surgeon
engaged by the employee, and the employer has no | ||
physician or surgeon
present at such examination, it shall be | ||
the duty of the physician or
surgeon making the examination at | ||
the instance of the employee, to
deliver to the employer, or | ||
his representative, a statement in writing
of the condition and | ||
extent of the examination and findings to the same
extent that | ||
said physician or surgeon reports to the employee and the
same | ||
shall be an exact copy of that furnished to the employee, said |
copy
to be furnished the employer, or his representative, as | ||
soon as
practicable but not later than the time the case is set | ||
for hearing.
Such delivery shall be made in person either to | ||
the employer, or his
representative, or by registered mail to | ||
either, and the receipt of
either shall be proof of such | ||
delivery. If such physician or surgeon
refuses to furnish the | ||
employer with such statement to the same extent
as that | ||
furnished the employee, said physician or surgeon shall not be
| ||
permitted to testify at the hearing next following said | ||
examination.
| ||
(b) Whenever, after the death of an employee, any party in | ||
interest
files an application for adjustment of claim under | ||
this Act, and it
appears that an autopsy may disclose material | ||
evidence as to whether or
not such death was due to the | ||
inhalation of silica or asbestos dust, the
commission, upon | ||
petition of either party, may order an autopsy at the
expense | ||
of the party requesting same, and if such autopsy is so | ||
ordered,
the commission shall designate a competent | ||
pathologist to perform the
same, and shall give the parties in | ||
interest such reasonable notice of
the time and place thereof | ||
as will afford a reasonable opportunity to
witness such autopsy | ||
in person or by a representative.
| ||
It shall be the duty of such pathologist to perform such | ||
autopsy as,
in his best judgment, is required to ascertain the | ||
cause of death. Such
pathologist shall make a complete written | ||
report of all his findings to
the commission (including | ||
laboratory results described as such, if any).
The said report | ||
of the pathologist shall contain his findings on
post-mortem | ||
examination and said report shall not contain any conclusion
of | ||
the said pathologist based upon the findings so reported.
| ||
Said report shall be placed on file with the commission, | ||
and shall be
a public record. Said report, or a certified copy | ||
thereof, may be
introduced by either party on any hearing as | ||
evidence of the findings
therein stated, but shall not be | ||
conclusive evidence of such findings,
and either party may | ||
rebut any part thereof.
|
Where an autopsy has been performed at any time with the | ||
express or
implied consent of any interested party, and without | ||
some opposing
party, if known or reasonably ascertainable, | ||
having reasonable notice of
and reasonable opportunity of | ||
witnessing the same, all evidence obtained
by such autopsy | ||
shall be barred upon objection at any hearing. This
paragraph | ||
shall not apply to autopsies by a coroner's physician in the
| ||
discharge of his official duties.
| ||
(Source: P.A. 81-1482.)
| ||
(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
| ||
Beginning January 1, 1981 , 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
5 members of the Commission that
such | ||
argument be held before all available members of the | ||
Commission)
pursuant to the rules and regulations of the | ||
Commission. A panel of 3
members, which shall be comprised of | ||
not more than one representative
citizen of the employing class | ||
and not more than one representative citizen
of the employee | ||
class, shall hear the argument; provided that if all the
issues | ||
in dispute are solely the nature and extent of the permanent | ||
partial
disability, if any, a majority of the panel may deny | ||
the request for such
argument and such argument shall not be | ||
held; and provided further that 7
5
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 pay
to the Commission the | ||
sum of 80 cents per page of testimony taken before
the | ||
Commission, and 35 cents per page of all other matters | ||
contained in
such record, except as otherwise provided by | ||
Section 20 of this Act.
Payment for photostatic copies of | ||
exhibit shall be extra. It shall be
the duty of the | ||
Commission upon such payment, or failure to pay as
| ||
permitted under Section 20 of this Act, to prepare a true | ||
and correct
typewritten 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.
| ||
In its decision on review the Commission shall | ||
determine in each
particular case the amount of the | ||
probable cost of the record to be
filed as a return to the | ||
summons in that case and 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 payment by
filing a | ||
receipt showing payment or an affidavit of the attorney | ||
setting
forth that payment has been made of the sums so | ||
determined 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.
| ||
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.
| ||
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. 93-721, eff. 1-1-05.)
| ||
Section 95. Applicability. The amendatory changes to the | ||
first paragraph of subsection (f) of Section 7 relating to | ||
payment for burial expenses, subsections (a) and (b) of Section | ||
8, and subsections (h), (k), and (l) of Section 19 of the | ||
Workers' Compensation Act and subsections (k) and (k-1) of | ||
Section 19 of the Workers' Occupational Diseases Act apply to | ||
accidental injuries or diseases that occur on or after February | ||
1, 2006. | ||
Section 98. Inseverability. The provisions of this Act are | ||
mutually
dependent and inseverable. If any provision or its | ||
application to any person
or circumstance is held invalid, then | ||
this entire Act is invalid. | ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law. |