It may be important to put in an Outlook appointment into your system to keep track to the extent this will effect overall claims handling.

· The Amendment to Section 1 require an employee to bear the burden of showing, by a preponderance of the evidence, they have sustained an accidental injury arising out of and In the course of employment.

· The Amendment went into full effect last Tuesday, June 28, 2011.

· The Amendments to Section 1.1 of the Illinois Workers’ Compensation Act implements Standards of Conduct for Commissioners and Arbitrators, who shall conduct hearings in a fair manner without bias or prejudice. Portions of the canons of the Code of Judicial Conduct have been adopted and are to apply to the Commission and Arbitrators. We also note that pre-trials are specifically addressed as a practice that is permitted as long as the pretrial is performed in accordance with the rules of the Commission.

· This Amendment went into full effect last Tuesday, June 28, 2011.

· The Amendment to Section 4(a)(2) of the Illinois Workers’ Compensation Act specifically defines Employee Leasing Companies under the Act and compels them to provide the Commission with proof any client company of the Employee Leasing Firm is listed as an additional named insured on their policy.

· This Amendment went into full effect last Tuesday, June 28, 2011.

· The Amendment to Section 4(d) of the Illinois Workers’ Compensation Act allows an investigator with the Illinois Workers' Compensation Commission Insurance Compliance Division to issue citations to employers that are not in compliance with their obligation to establish workers’ compensation insurance under the Act. Fines range from $500.00 to $2,500.00 for violations.

· This Amendment went into full effect last Tuesday, June 28, 2011.

· The Amendment creating Section 4b (not to be confused with section 4(b), which is a subsection of 4) of the Workers’ Compensation Act is an entirely new section. It creates a collective bargaining “pilot program” which applies only to businesses involved in “construction.”

· This Amendment went into full effect last Tuesday, June 28, 2011.

· The Amendment to Section 8(a) of the Illinois Workers’ Compensation Act clarified medical bill payment shall fall within the fee schedule even where the accounts receivable of the provider are sold to a third party (e.g., the Med-Finance-type groups). This went into full effect last Tuesday.

· The Amendment creating Section 8(a)(4) of the Illinois Workers’ Compensation Act outlines when an employer has an approved “preferred provider program” pursuant to Section 8.1(a), the employer shall, in writing on a form promulgated by the Commission, inform the employee of the preferred provider program and then subsequent to the report of injury, 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 the medical providers to which the employee is entitled.

· We have requested the “form promulgated by the Commission” mentioned in the Amendment above and will continue to ask on a weekly basis until they promulgate it. When that form is in existence, this Amendment will be in full effect.

· The Amendment to Section 8(a) Temporary Partial Disability Computation alters the existing computation to hold employers liable for payment to Petitioner of two-thirds the difference between the average amount the employee would be able to earn in his regular employment and his/her gross earnings at the modified employment position. The Act in its existing form requires payment of temporary partial disability at two-thirds the difference between the average amount the employee would be able to earn in his/her regular employment and the net earnings at the modified employment position.

· This Amendment went into effect last Tuesday, June 28, 2011.

· The Amendment to Section 8(d)(1) of the Illinois Workers’ Compensation Act confirms any award for wage differential for accidents occurring after September 1, 2011 shall be effective only until the employee reaches the age of 67 or five years from the date the award becomes final, whichever is later.

· This Amendment only affects “accidents occurring after September 1, 2011” and doesn’t affect existing claims. You do not have to re-reserve any current claims to reflect the coming change.

· The Amendment to Section 8(e)(9) the Illinois Workers’ Compensation Act specifically delineates hand injuries involving carpal tunnel syndrome due to repetitive or cumulative trauma be returned to their pre-2005 scheduled amount of 190 weeks, and places a disability limit of 15% loss of use of the hand in such cases, unless clear and convincing evidence can show an award should exceed this amount. In such cases the award should not exceed 30% loss of use of the hand.

· This Amendment goes into effect for CTS claims occurring on or after last Tuesday, June 28, 2011. You do not and should not re-reserve claims prior to that date.

· The Amendment to Section 8.1(b) of the Illinois Workers’ Compensation Act delineates the determination of permanent partial disability. For all accidents occurring on or after September 1, 2011, permanent partial disability shall be established by a licensed physician reporting on the level of impairment in writing.

· Section 8.2 of the Illinois Workers’ Compensation Act contains medical fee schedule modification which is the major cost-saving mechanism in the 2011 Amendments. The changes are as follows:

o Out of state providers shall be reimbursed at the lesser of that state’s fee schedule or the State of Illinois fee schedule. In the event there is no fee schedule in the outside jurisdiction, the lesser of the actual charge or the Illinois Fee Schedule shall apply. This applies as of last Tuesday, June 28, 2011.

o The Commission is to maintain schedules for procedures and services including ambulatory surgical treatment centers, facilities and prescriptions filled and dispensed outside of a licensed pharmacy.

o Beginning January 1, 2012 the fee schedule amount shall be grouped into geographic regions which are consolidated from the present geographic breakdown. These include 1) Cook County, 2) DuPage, Kane, Lake and Will County 3) Bond, Calhoun, Clinton, Jersey (and other downstate counties) 4) any counties not delineated in the Act specifically. In the event any fee schedule regions overlap, the Commission shall average the two fee schedule amounts.

o If a fee schedule amount is in place, effective September 1, 2011, the charge shall be no more than 70% of the fee scheduled amount. If a fee schedule amount cannot be determined, the default reimbursement shall remain at 76% until September 1, 2011 at which time a 53.2% reimbursement rate shall apply.

o Prescriptions filled outside a licensed pharmacy shall be reimbursed at a rate that does not exceed the Average Wholesale Price, plus $4.18 as a dispensing fee.

o Implants shall be reimbursed at 25% above the manufacturer’s invoice price, less rebates.

o Please note that the timeline for prompt payment has been reduced from 60 days to 30 days whereupon a provider provides a substantially all data required to pay the bill. This imparts an obligation on the insurance companies or self-insureds to promptly identify the basis for non-payment within a 30-day period rather than the prior 60 day window.

o Of particular relevance, providers may no longer bill or attempt to recover from an employee the difference between the provider’s charge and the amounts paid by the employer for treatment determined by the Commission to be excessive or unnecessary. This is significant to the extent that any denied treatment which has been deemed excessive by the Commission will prohibit those providers from alternatively seeking payment directly from the claimant.

o The effective dates of these changes are various.

· The Amendments to Section 8.7(i) of the Illinois Workers’ Compensation Act creates a new section on implementation of UR for treatment after September 1, 2011.

· This relates to care for any injury but doesn’t start until September 1, 2011.

· The Amendment to Section 11 of the Illinois Workers’ Compensation Act provides an intoxication defense, however, this was greatly limited. The new section confirms no compensation shall be payable if an employee’s intoxication is the proximate cause of the employee’s accidental injury at the time of the accident, or if the employee was so intoxicated the intoxication constituted a departure from the employment.

· This went into effect last Tuesday, June 28, 2011.

· The Amendments to Sections 13 and 14 ended the terms of the Illinois Workers’ Compensation Advisory Board and all sitting Arbitrators.

· To our knowledge a lot of the Advisory Board members and Arbitrators have reapplied and, as we indicated in the first article above, we are awaiting the decision of the Governor on all of them

· The Amendment to Section 16 created an odd gift ban relating to lawyers and took effect on June 28, 2011.

· Section 25.5 of the Illinois Workers’ Compensation Act addresses WC fraud and delineates unlawful Acts and penalties for various violations.

· The Amendment went into effect on June 28, 2011.

KCBA Blog

7-7-2011; Effective dates on the 2011 Amendments to the Illinois Workers’ Compensation Act for your calendar and ours