Synopsis: If You Handle IL WC Claims, the Rates are Finally Updated so get the updated version of Shawn R. Biery’s Rate Sheet.
Editor’s comment: The new IL WC minimums and maximums have been posted and our updated KCB&A IL WC Rate Sheet is now available via email or snail mail if you prefer the fancy laminated version. We note rates continue to increase based upon the reported increase in the statewide average weekly wage however the increase was not as significant as the last. The reality on the streets still doesn’t seem to match the increase however as noted in the past, since the 1980’s, the IL WC Act provides a formula which effectively insures no matter how poor the IL economy is doing, your WC minimum rates keep climbing.
We caution our readers to pay attention to the fact the IL WC statutory maximum PPD rate is not updated until January 2015 and will then change retroactively from July 1, 2013 to present. The new PPD max rate becomes retroactively effective when published. If this isn’t clear, send a reply or email IL WC rate wiz, Shawn R. Biery at firstname.lastname@example.org.
The current TTD weekly maximum is $1,341.07. A worker has to make over $2,011.61 per week or $104,603.46 per year to hit the new IL WC maximum TTD rate.
The new IL WC minimum death benefit is 25 years of compensation or $502.90 per week x 52 weeks in a year x 25 years or $653,770.00! The new maximum IL WC death benefit is $1,341.07 times 52 weeks times 25 years or a lofty $1,743,391.00 plus burial benefits of $8,000. These numbers make it very important to keep your workplace safe and free from hazards.
The best way to make sense of all of this is to get Shawn Biery’s awesome and easy-to-understand IL WC Rate Sheet. If you want one, they are free so simply reply or email Shawn at email@example.com and we will send it along. If you would like fancy laminated copies, copy Marissa at firstname.lastname@example.org and let her know the number of copies and your MAILING ADDRESS!
Synopsis: Closing WC Claims in Illinois Faster Than Your Competition.
Editor’s comment: Our motto at KCB&A is “The Only Good File is a Closed File.” One great thing about IL WC is you can close WC claims effectively forever, if you know the rules. Here are some thoughts on closing IL WC claims, full and final, faster than your competition.
First, you have to investigate the accident with intensity needed to match the severity of the injuries. We can’t tell you how much to investigate but the more severe or questionable events require more intense investigation—you have to make the informed call on how much is needed. If you want our investigative forms, send a reply. We call a poor or ineffective accident investigation the equivalent of being on the high seas in a boat without a rudder. You may stay afloat for a time but you have little control of your destiny.
Second, get a signed HIPAA-GINA compliant release to facilitate review of medical records and histories. If you need our form, send a reply. When you review and compare medical histories to the accident investigation, you should be able to tell if you have an accepted loss or not. If the histories mix properly with your investigation, you need to accept and pay the claim. If they don’t, consult with a defense attorney to consider controverting the claim.
Third, when you start to manage an accepted claim—always project the beginning, middle and end. Set targets for your outcomes. Then push hard to make those targets occur.
Fourth, timely pay and process all necessary and related medical bills. If you decide to dispute medical care, use UR and/or IME’s or tough defense counsel from KCB&A to do so. Please remember, you can’t close/settle/try most IL WC claims without a determination by a doctor that Petitioner is MMI and all medical bills are processed and paid under our IL WC Medical Fee Schedule.
Fifth, get Petitioner back to charity/light/medium or regular work—like number Four above, you can’t settle, full and final, until Petitioner is back to some sort of work.
Sixth, when you have the medical bills paid and Petitioner is back to work, make an offer of settlement. Don’t ever ask the other side what they want—do your homework or ask a defense team member at KCB&A for their evaluation and make an offer.
Seventh, if you have made a fair offer and the other side won’t take it, start to push for closure with the rest of the tools available.
o Engage the employer to convey the offer to the worker and push for closure;
o Engage the Arbitrator assigned to seek a pretrial and push for closure;
o Don’t agree or allow your assigned defense attorney to agree to continuances—attend the trial settings and ask everyone to push for closure.
The defense team at KCB&A wants our readers to understand IL WC Arbitrators are committed to timely closure of files when the defense industry does their job, gets medical bills processed and paid and insures injured workers are back to work. We can help with any and all of it.
We appreciate your thoughts and comments. Please post them on our award-winning blog.
Synopsis: Electronic Medical Billing to Hit IL WC System Some Day.
Editor’s comment: We are sure this change is going to keep coming at the WC claims/risk industry and we are all going to have to adapt. Having withdrawn its rules on e-billing in 2013, the Illinois Insurance Department is trying, trying again to adopt rules that will require insurers and employers to accept, process and pay electronic medical bills.
The 2011 Amendments to the IL WC Act “required” the IL Insurance Department to adopt rules for e-billing by January 1, 2012. Like many things our legislature does with the IL WC Act, there is no penalty for not following the legislative fiat, other than occasional embarrassment which is readily shrugged off by the administrators. The plan was all insurance carriers and employers would accept electronic medical payment claims no later than June 30, 2012. Oops, it appears those dates came and went.
Following enactment of the 2011 Amendments, the e-billing standards were finally published in November 2012 and were then withdrawn in 2013, to supposedly be replaced by more updated rules. Those new rules have been published and we will all have to consider following them. At some point, we assure our readers you are going to have to accept and process bills following the e-billing rules.
At present, the IL Insurance Department is soliciting comment from anyone interested about the new rules they have promulgated—you have 45 days from August 8, 2014 to do so. The comments need to be directed to Joe Clennon, Ass’t General Counsel of the IL Insurance Department, 320 West Washington St., Springfield, IL 62676.