Signed by Governor Pat Quinn

Vote Smart's Synopsis:

Vote to pass a bill that amends the state workers' compensation system.

Highlights:

• Authorizes the Director of the Department of Central Management Services to prepare and implement a plan for the State and its employees that provides for, but is not limited to, the following (Sec. 5):
• The purchase of workers' compensation liability;
• A combination of purchased insurance and self-insurance for workers' compensation liability, including reinsurance or stop-loss insurance; or
• Third party administration of self-insurance, in whole or in part, for workers compensation liability.

• Requires any contract for insurance or third party administration to be on terms consistent with the State policy, awarded in compliance with the Illinois Procurement Code based on, but not limited to, the following (Sec. 5):
• Administrative cost; and
• Service capabilities of the carrier or other contractor and premiums, fees, or charges.

• Establishes the State Workers' Compensation Program Advisory Board to review, assess, and provide recommendations to improve the State workers compensation program and to ensure that the State manages the program in the interests of injured workers and taxpayers (Sec. 5).

• Requires an employee to show by a preponderance of the evidence that he or she has sustained accidental injuries arising out of and in the course of the employment to obtain compensation (Sec. 5).

• Establishes a "Standard of Conduct" for Commissioners and Arbitrators (Sec. 4).

• Requires every Employee Leasing Company to provide the following information to the Commission or any entity designated by the Commission regarding each workers' compensation insurance policy issued to the ELC (Sec. 4):
• Any client company of the ELC listed as an additional named insured;
• Any informational schedule attached to the master policy that identifies any individual client company's name, FEIN, and job location; and
• Any certificate of insurance coverage document issued to a client company specifying its rights and obligations under the master policy that establishes both the identity and status of the client, as well as the dates of inception and termination of coverage, if applicable.

• Requires employers to be in compliance with its obligation to have workers compensation insurance and establishes a fine to be no less than $500 and not exceed $2,500 for employers who are not in compliance with the Workers Compensation Insurance Act (Sec. 4).

• Requires the Director of the Department of Labor to adopt a selection process to designate 2 organizations made up of affiliates who are the exclusive representatives of construction employers, recognized or certified pursuant to the National Labor Relations Act, to participate in the collective bargaining pilot program (Sec. 4).

• Authorizes the Commission and the courts of Illinois to recognize any provision in a collective bargaining agreement between any construction employer and a labor organization, which relates to workers' compensation with an agreement that is limited to but need not include all of the following (Sec. 4):
• An alternative dispute resolution ("ADR") system to supplement, modify or replace the procedural or dispute resolution provisions of this Act;
• An agreed list of medical treatment providers that may be the exclusive source of all medical and related treatment provided under this Act;
• The use of a limited list of impartial physicians to conduct independent medical examinations; -The creation of a light duty, modified job, or return to work program individuals;
• The use of a limited list of individuals and companies for the establishment of vocational rehabilitation or retraining programs that may be the exclusive source of rehabilitation and retraining services provided under this Act; or
• The establishment of joint labor management safety committees and safety procedures.

• Specifies that nothing in the previous set of standards shall be construed to authorize any provision in a collective bargaining agreement that diminishes or increases a construction employer's entitlements under this Act or an employee's entitlement to benefits as otherwise set forth in this Act (Sec. 4).

• Requires a form of agreement that demonstrates the following (Sec. 7):
• The construction employer or group of construction employers and the recognized or certified exclusive bargaining representative have entered into a binding collective bargaining agreement adopting the ADR plan for a period of no less than 2 years;
• Contractual agreements have been reached with the construction employer's workers' compensation carrier, group self-insurance fund, and any excess carriers relating to the ADR plan;
• Procedures have been established by which claims for benefits by employees will be lodged, administered, and decided while affording procedural due process;
• The plan has designated forms upon which claims for benefits shall be made;
• The system and means by which the construction employer's obligation to furnish medical services and vocational rehabilitation and retraining benefits shall be fulfilled and provider selected; and
• The method by which mediators or arbitrators are to be selected.

• Specifies that employees' claims for workers' compensation shall adhere to the following guidelines (Sec. 4):
• Claims for benefits shall be filed with the ADR plan administrator within those periods of limitation prescribed by this Act. Within 10 days of the filing of a claim, the ADR plan administrator shall serve a copy of the claim application upon the Commission;
• Settlements of claims presented to the ADR plan administrator shall be evidenced by a settlement agreement. All such settlements shall be filed with the ADR plan administrator; and
• Upon assignment of claims, unless settled, mediators and arbitrators shall render final orders containing essential findings of fact, rulings of law and referring to other matters as pertinent to the questions at issue.

• Requires each ADR plan administrator to annually submit a report to the Commission containing the following information (Sec. 4):
• The number of employees within the ADR program; -The number of occurrences of work-related injuries or diseases;
• The breakdown within the ADR program of injuries and diseases treated;
• The total amount of disability benefits paid within the ADR program;
• The total medical treatment cost paid within the ADR program;
• The number of claims filed within the ADR program; and
• The disposition of all claims.

• Establishes that the following shall apply for injuries occurring on or after the effective date of this Act, and only when an employer has an approved preferred provider program pursuant to this act (Sec. 8):
• The employer shall, in writing, inform the employee of the preferred provider program;
• Subsequent to the report of an injury by an employee, the employee may choose in writing at any time to decline the preferred provider program, in which case that would constitute one of the two choices of medical providers to which the employee is entitled; and
• Prior to the report of an injury by an employee, when an employee chooses non-emergency treatment from a provider not within the preferred provider program, that would constitute the employee's one choice of medical providers to which the employee is entitled.

• Specifies for accidental injuries that occur on or after September 1, 2011, an award for wage differential under this subsection shall be effective only until the employee reaches the age of 67 or 5 years from the date the award becomes final, whichever is later (Sec. 8).

• Authorizes employers to utilize a preferred provider program approved by the Illinois Department of Insurance to satisfy its liabilities under this Act for the provision of medical treatment to injured employees (Sec. 8).

• Requires all preferred provider programs to meet the following requirements (Sec. 8):
• The provider network shall include an adequate number of occupational and non-occupational providers;
• The provider network shall include an adequate number and type of physicians or other providers to treat common injuries experienced by injured workers in the geographic area where the employees reside;
• Medical treatment for injuries shall be readily available at reasonable times to all employees;
• Physician compensation shall not be structured in order to achieve the goal of inappropriately reducing, delaying, or denying medical treatment or restricting access to medical treatment; and
• Before entering into any agreement, a program shall establish terms and conditions that must be met by noninstitutional providers wishing to enter into an agreement with the program. These terms and conditions may not discriminate unreasonably against or among noninstitutional providers.

• Establishes that for accidental injuries occurring on or after September 1, 2011, permanent partial disability shall be established using the following criteria (Sec. 8):
• A physician licensed to practice medicine in all of its branches preparing a permanent partial disability impairment report shall report the level of impairment in writing and the report shall provide appropriate measurements of impairment that include, but are not limited to, the following:
• Loss of range of motion;
• Loss of strength;
• Measured atrophy of tissue mass consistent with the injury; and
• Any other measurements that establish the nature and extent of the impairment.

• Specifies that in determining the level of permanent partial disability, the Commission shall base its determination on the following factors (Sec. 8):
• The reported level of impairment;
• The occupation of the injured employee;
• The age of the employee at the time of the injury;
• The employee's future earning capacity; and
• Evidence of disability corroborated by the treating medical records.

• Establishes that for procedures, treatments, services, or supplies covered under this Act and rendered or to be rendered on or after September 1, 2011, the maximum allowable payment shall be 70 percent of the fee schedule amounts (Sec. 8).

• Specifies that no compensation shall be payable if the employee's intoxication is the proximate cause of the employee's accidental injury or at the time the employee incurred the accidental injury, the employee was so intoxicated that the intoxication constituted a departure from the employment (Sec. 11).

• Amends the Commissioner training program to include training on the following aspects (Sec. 13):
• Professional and ethical standards pursuant to Section 1.1 of this act;
• Detection of workers' compensation fraud and reporting obligations of Commission employees and appointees;
• Standards of evidence-based medical treatment and best practices for measuring and improving quality and health care outcomes in the workers compensation system; and
• Substantive and procedural aspects of coal workers pneumoconiosis cases.

• Requires each commission to complete 20 hours of training in the above-noted areas during every 2 years such Commissioner shall remain in office (Sec. 13).

• Requires the fraud and insurance non-compliance unit to submit a written report annually to the chairman of the Commission including, at a minimum, the following information (Sec. 25):
• The number of allegations of insurance non-compliance and fraud reported to the fraud and insurance con-compliance unit;
• The source of the reported allegations;
• The number of allegations investigated by the fraud and insurance non-compliance unit; and
• The number of criminal referrals made in accordance with this Section and the entity to which the referral was made.

Full Bill Text