Significant changes were made to the Workers’ Compensation Act by Public Act 97-018, which was effective June 28, 2011. Amendatory provisions included changes to Commission operations, fraud requirements, the medical fees and schedules, utilization reviews, and insurance compliance.
Changes to the Illinois Workers’ Compensation Commission
• The terms of all Arbitrators were terminated as of the end of business on July 1, 2011.
Current Arbitrators continued to serve until they were reappointed or their successors were appointed.
• Arbitrators appointed by the Governor are now subject to the advice and consent of the Senate, for the initial terms immediately after the effective date of the Act.
• All new Arbitrators, not currently serving on the effective date of the Act, must now be licensed to practice law in Illinois and must keep that status current throughout their term(s) of service.
• Arbitrators and Commissioners are required to take at least 20 hours of training every 2 years while in office regarding professional and ethical standards, detection of fraud, evidence-based medical treatment, and Coal Workers' Pneumoconiosis.
• At least 3 Arbitrators are required to be assigned to each hearing site and cases must be randomly assigned to them. Arbitrators may not serve more than 2 years of any 3-year term in any single county, other than in Cook.
• All claims of current or former employees of the Commission must be adjudicated by certified independent Arbitrators not employed by the Commission. Arbitrators shall be selected by the Commission Chairman from a list generated by the Commission Review Board. Decisions of the independent Arbitrator shall become a decision of the Commission but are subject to judicial review.
• The terms of members of the Workers' Compensation Advisory Board were terminated immediately and the Governor shall make new appointments within 30 days.
• Codifies that the Petitioner has the burden of proving by a preponderance of evidence that the injuries arose out of and in the course of employment.
• Caps repetitive Carpal Tunnel Syndrome awards to 15% of the loss of the use of a hand unless the petitioner proves greater disability by clear and convincing evidence, at which time the award is capped at 30% of the loss of the use of the hand.
• Provides that to determine permanent partial disability regarding accidents on or after September 2011, a physician submitting an impairment report shall use the most recent AMA (American Medical Association) guidelines on impairment, including objective criteria. The level of disability shall be based on that impairment report, the occupation of the petitioner, the age of the petitioner, the future earning capacity of the petitioner, and evidence of disability in the treating providers' medical records.
The relevance and weight of factors in addition to the impairment report shall be included in all decisions relating to permanent partial disability.
• The Act also made changes to medical fees and schedules, utilization reviews and insurance compliance provisions.
Changes Related to Workers’ Compensation Fraud
• Eliminates the requirement that a report of fraud shall be forwarded to the alleged wrongdoer with the verified name and address of the complainant.
• Requires the fraud unit to refer any violation to the Special Prosecutions Bureau of the Criminal Division of the Office of the Attorney General.
• Sets penalties for workers' compensation fraud based on the amount of money involved in the attempted fraud, from a Class A misdemeanor (less than $300) to a Class 1 felony (more than $100,000). Requires restitution be ordered in workers' compensation fraud cases.
• The fraud unit shall procure software to identify waste and fraud, and shall make
Other Significant Changes at CMS and Department of Insurance
• Allows the Director of CMS to implement a system, including purchasing workers’
compensation insurance and/or hiring a third party administrator to administer claims of State employees.
• Establishes the State Workers' Compensation Program Advisory Board within CMS to review and assess the workers' compensation program involving State employees, and to advise CMS regarding improvements to the system. The board shall consist of 5 voting members, one appointed by the Governor who serves as Chairman, and one each by the four legislative leaders. The Board is required to meet at least three times annually and to submit an annual written report each July to the Governor, General Assembly, and CMS with recommendations for improving the system.
• Requires the Director of Insurance to submit annual reports to the General Assembly, Governor, and the Chairman of the Commission about work accidents, the workers' compensation insurance market in Illinois, and other matters relating to claims, awards, and medical expenditures.
State Workers’ Compensation Program Advisory Board
Public Act 97-018 created the State Workers’ Compensation Program Advisory Board located within CMS. The Board was created 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. The Board's make up is as follows:
• The Governor shall appoint one person to the Board, who shall serve as the Chairperson.
• The Speaker of the House of Representatives, the Minority Leader of the House of Representatives, the President of the Senate, and the Minority Leader of the Senate shall each appoint one person to the Board.
• The Director of the Department of Central Management Services, the Attorney
General, the Director of the Department of Insurance, the Secretary of the Department of Transportation, the Director of the Department of Corrections, the Secretary of the Department of Human Services, the Director of the Department of Revenue, and the Chairman of the Illinois Workers' Compensation Commission, or their designees, shall serve as ex officio, non-voting members of the Board.
The Board shall meet at least three times per year or more often if the Board deems it necessary or proper. By September 30, 2011, the Board shall issue a written report, to be delivered to the Governor, the Director of the Department of Central Management Services, and the General Assembly, with a recommended set of best practices for the State workers'
compensation program. By July 1 of each year thereafter, the Board shall issue a written report, to be delivered to those same persons or entities, with recommendations on how to improve upon such practices.
The State Workers’ Compensation Program Advisory Board held its first meeting January 12, 2012. However, as of March 1, 2012, the Board has not issued a report of workers’
compensation best practices as is required by Public Act 97-018.
STATE WORKERS’ COMPENSATION PROGRAM ADVISORY BOARD RECOMMENDATION
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The Department of Central Management Services, in conjunction with the State Workers’ Compensation Program Advisory Board, should develop recommended best practices for the Stateworkers' compensation program, as required by Public Act 97-018.
DEPARTMENT
RESPONSE Agreed. The Board, appointed by the Governor and the General Assembly, is required to issue a written report to be delivered to the Governor’s Office, the Director of CMS, and the General Assembly, including a recommended set of best practices. Future reports will include recommendations for improvements. CMS will evaluate the Board’s recommendations and work to implement and administer the best practice and future improvement recommendations taking into consideration relevant laws, policies and available resources.