News

May 02, 2011

Senate Amendment 3 to House Bill 1698 was introduced in the Senate on May 26, 2011.  The following represents the most substantive proposed changes:

• Compensability standard codified –an employee bears the burden of showing, by a preponderance of the evidence, that an accidental injury arose out of and in the course of the employment.
• Carpal Tunnel Cases – The schedule loss of a hand is reduced from 205 weeks to 190 weeks only for carpal tunnel syndrome caused by repetitive trauma.  The PPD award for such injuries shall not exceed 15% loss of use of the hand, except for cause shown by clear and convincing evidence, in which the case shall not exceed 30%.
• Caps on wage loss – For accidents occurring on or after 9-1-11, a wage differential under 8(d)1 is payable until the employee reaches the age of 67 or 5 years from the date the award becomes final, whichever is later.
• Standards for determining PPD – for accidents occurring on or after 9-1-11, a licensed physician shall report the level of impairment in writing using AMA guidelines.  The Commission shall base its PPD determination on the following factors; reported level of impairment, occupation, age, future earning capacity, and evidence contained within the medical records.  No single factor shall be the sole determination of disability.
• Intoxication – For accidents occurring on or after 9-1-11, if intoxication is the proximate cause of the injury and if the employee is so intoxicated that the intoxication constitutes a departure from employment, then compensation is denied.  If an employee refuses to submit to blood, breath or urine tests, there is a rebuttable presumption the employee was intoxicated.
• Preferred Provider Networks – The Employer may utilize a preferred provider program. An employee utilizing a preferred provider program shall only be allowed to select from the participating network and the employer is responsible for payment of all medical expenses from referrals within the network.  After the report of injury, the employee may choose to decline the preferred provider network in writing which constitutes one of the employee’s two choices of doctors.  Before the report of injury, if the employee chooses a provider not within the preferred program, it counts as a choice of physician.
• Medical Fee Schedule – For procedures, treatments, services or supplies rendered or to be rendered on or after 9-1-11, the reimbursement shall be 70% of the fee schedule (30% reduction).  Prescriptions are subject to the fee schedule.  The time for payment of medical bills is reduced to 30 days from 60 days and interest applies to non-payment of bills.  Insurers and employers shall keep electronic claims on or before 1-1-12.
• Utilization Review – A medical provider shall submit to UR once given proper notice.  If services are denied by UR, the employee has the burden of showing by a preponderance of evidence that the variance of the standard of care is necessary.  An admissible UR shall be considered by the Commission along with all other evidence and in the same manner and must be addressed along with all other evidence.  Applicable to all health care services provided or proposed on or after 9-1-11.
• Arbitrator’s terms abolished – All arbitrator’s terms are terminated effective 7-1-11; they shall continue to serve until appointed by the governor or until their successor is chosen.  The initial appointment of all arbitrators is by the governor with the advice and consent of the Senate.  The full Commission will make subsequent reappointments.  Every arbitrator who has not previously served as an arbitrator shall be a licensed attorney.  For cases outside of Cook County, there shall be no fewer than three arbitrators assigned to a hearing sight and cases will be randomly assigned.  No arbitrator shall be assigned to one hearing location for more than 2 years.
• Collective Bargaining Pilot Program – The Department of Labor shall designate two labor organizations to implement Alternative Dispute Resolution with  binding arbitration.
• Fraud provisions – The Department of Insurance shall investigate fraud and report to the Governor and leaders on an annual basis.

Changes may be made during the legislative process.  Our firm will provide updates accordingly.