Workers’ Compensation Law

(Raoul, D-Chicago; Bradley, D-Marion) rewrites the Workers’ Compensation Act. Many of the following changes will take effect on Sept. 1, 2011. (1) Requires the employee prove by a preponderance of the evidence that the accidental injuries were sustained arising out of an in the course of the employment. (2) Allows two construction unions to do a pilot program in which workers’ compensation is collectively bargained. (3) A § 8(d(1) wage differential award is effective only until the employee reaches 67 years of age or five years from the date of the award becomes final, whichever is later. (4) Limits hand injuries to 190 weeks. A recovery for carpal-tunnel may not exceed 15% loss of use of a hand unless cause is shown otherwise by clear and convincing evidence in which the award may not exceed 30% loss of use of the hand. (5) Authorizes a Preferred Provider Network of physicians and qualifies the petitioner’s right to have two separate choices of medical providers. If an injured worker refuses to be treated by the employer-directed PPO network, that refusal counts as his or her first choice of physician. (6) Requires a physician to use the AMA’s Guides to the Evaluation of Permanent Impairment in determining the level of impairment. Creates criteria for the physician in that evaluation. Requires the Commission to base its determination of the PPD on the following criteria: (a) the reported level of impairment by the physician; (b) the employee’s occupation; (c) the employee’s age at the time of injury; (d) the employee’s future earning capacity; and (e) evidence of disability corroborated by the treating medical records. No single criterion may be the sole determinant of disability. (7) Reduces out-of-state medical services to that state’s fee schedule, or if that state doesn’t have a fee schedule, the lesser of the actual charge or the amount of the Illinois fee schedule where the employee resides. (8) Creates four geo-zip regions for the Illinois fee schedule effective Jan. 1, 2012. (9) Reduces charges for implants to 25% above the net manufacture’s invoice price and shipping costs minus any rebates. (10) Reduces the fee schedule by 30% for any medical services rendered after Sept. 1, 2011. (11) Utilization-review evaluations will now include nationally recognized treatment guidelines and evidence-based medicine. (12) An employee may not be compensated if the employee’s intoxication is the proximate cause of his or her injuries or if the employee was so intoxicated that it consisted of a departure from the employment. (13) Terminates all arbitrators effective July 1, 2011, but they continue to serve until reappointed or their successors are appointed. All future arbitrators must be licensed Illinois attorneys. Each hearing site will include at least three different arbitrators, and the cases will be assigned on a random basis. Every two years the case will be assigned to a different arbitrator. (14) Prohibits attorneys from giving gifts to someone for referring a case to them unless it is food and drink less $75 per day. (15) Adds extensive reporting requirements for insurance carriers.