News

August 10, 2026

On August 7, Governor Pritzker signed House Bill 5228 into law, and the amendments to the Illinois Workers’ Compensation Act are now in effect. These changes impact several key areas of workers’ compensation claims administration, including burial expenses, utilization reviews (“URs”), and independent medical examinations (“IMEs”) addressing treatment.

To help our clients understand these significant changes and their practical implications, Wiedner & McAuliffe attorneys Mary Sabatino, Tim McNally and James Flannery will host a webinar on Tuesday, August 18 at 11 a.m. CT to discuss these new amendments and recommended claims-handling practices. Register today and join our webinar on August 18.

The law amends the Illinois Workers’ Compensation Act in the following ways:

1. Burial Expenses: The maximum burial expense benefit for death claims has increased from $8,000 to $10,000.
2. Utilization Reviews (“URs”)

• Any UR that includes a determination that proposed medical treatment is not medically and reasonably necessary (including UR appeals) must be made by a physician who:
  1. Holds a current and valid nonrestricted license in any U.S. jurisdiction and a current certification by a recognized American medical specialty board in the area or areas appropriate to the subject of the review; and
  2. Has experience treating and managing patients with the medical condition or disease for which the health care service is being requested.
• UR certifications shall be valid for three months immediately after the date on which the employee and treating provider receive the certification, or for the length of treatment as determined by the employee’s treater;
• If the certification is for a proposed surgery, it shall include three months of postoperative health care services as clinically indicated by the treater, or for the length of treatment as determined by the petitioner’s treating provider, completed by a licensed health care professional.

3. Independent Medical Examinations (“IMEs”): If an employer seeks an IME instead of a UR to address the reasonableness and necessity of the medical services proposed or provided, the IME report shall be provided to the employee or the employee’s representative and the employee’s treater within 90 days after receipt of the request for the examination of the reasonableness and necessity of treatment.

• The 90-day period begins when the employer receives the medical records from the treater requesting the proposed treatment;
• The physician who performs the IME to determine the reasonableness and necessity of treatment shall be board certified in the same specialty as the treater;
• If the employer fails to comply after receiving the medical records from the treater requesting the treatment, there is a rebuttable presumption that the employer shall be responsible for the payment of penalties and fees under Section 16 and subsection (l) of Section 19. This applies to the failure to authorize or approve treatment, as well as the failure to pay for treatment.

Recommended Best Practices

To mitigate some of the risks associated with potential penalties and fees, we would recommend implementing the following practices where applicable:

(1)   If the only issue at hand is a question on the reasonableness and necessity of treatment, consider a utilization review in lieu of an IME;

(2)   If seeking a UR, confirm the UR vendor is utilizing a practitioner in the same specialty as the treater, and has experience treating and managing patients with the medical condition or disease for which the health care service is being requested;

(3)   To effectively comply with the 90-day timeframe for IMEs, we would recommend immediately obtaining diagnostic films, as well as any preexisting medical records, as soon as you are made aware of that treatment, as to avoid any delays in obtaining an IME.

If you have questions regarding the impact of these changes on your business or claims practices, please join our webinar on Tuesday, August 18 at 11 a.m. CT. You may also contact Wiedner & McAuliffe attorneys James Flannery (jgflannery@wmlaw.com) and Tim McNally (tsmcnally@wmlaw.com) or reach us at 312.855.1105.