Changes in the illinois workers’ compensation act


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Changes in the illinois workers’ compensation act

  1. 1. Howard H. Ankin Ankin Law Office LLC162 West Grand Avenue Chicago, Illinois 60654 312.346.8780
  2. 2. Will County Forest Preserve District v. IWCC et al. 2012 Ill. App. 3d 110077WC (3rd Dist. 2012)  Filed February 17, 2012  Shoulder injury is now a Person as a Whole, NOT AN ARMMaximum PPD Rates  7/1/10 to 6/30/11 = $669.64  7/1/11 to 6/30/12 = $695.78
  3. 3. 1. Intoxication2. Repetitive Trauma (Carpal Tunnel)3. Wage Loss – Section 8(d)14. AMA Guidelines5. Utilization Review6. Preferred Provider Programs
  4. 4. Situations: 6 Beers at Lunch/Functional Alcoholic  No Significant Change Saturday Night Smoker  Major Change
  5. 5. 1. Follow Drug Test Laws (DUI Defense)2. Client gets to say if there is medical reason3. Rebuttable Presumption  Say what you’ve done and testify at trial.4. To Blow or Not to Blow…  If you do not = Rebuttable presumption that you were intoxicated and that intoxication was the proximate cause of your injury.
  6. 6. New:- Accident on or after effective date (6/28/11)- Accident Date: 1. Last Day Worked. 2. When Shown Medical to Be Work Related. 3. First Day of Treatment- Hand = 190 weeks.- 15% max unless shown by clear and convincing evidence, up to 30%Old:- Hand = 205 weeks.- Typically 20% awarded, higher awards possible by preponderance of evidence.
  7. 7.  New  5 years of benefits or up to age 67, whichever is later. Old:  Benefits for the rest of life per government life expectancy charts. TRY THE CASE FOR AN ODD-LOT TOTAL PERMANENT
  8. 8.  Question of Permanency 5 Factors Listed  No Single Factor Determines it.  Must have explanation in written order from Arb. Admissibility?  Take the deposition. Who can prepare reports?  “…in all of its branches.” Big Problem in Small Cases  Tip scales for Arb? Reconcile with case law?  Arm = MAW
  9. 9.  Evaluation of healthcare to determine appropriateness of level and quality of care.  Treating physician MUST assist. Employee must show by preponderance of evidence.  Consider with all other evidence. Rebuttable presumption of ZERO penalties when relied upon. Depositions of UR:  Employer must make them available by phone.  Employer pays.
  10. 10.  8.1a: Sets up the PPP  Must have adequate doctors available at reasonable times and in reasonable proximity. (Out of state/downstate)  Employer must provide NOTICE.  Certified Letter? No Notice = Coverage Disputes?  Only 3 programs currently set up.  CorVel, Coventry, HFN Change in the 2 Doctor Rule:  Can opt out of PPP (1st Choice)  2nd opinion DONE  Must opt out “IN WRITING”, “AT ANY TIME.”  Panel Doctor sends you to non-panel doctor:  WC pays but can veto the treatment and send you back to panel.  Requires hearing before the Commission (Respondent files)  Choose to go out of network…  Respondent cannot unreasonably withhold consent.  Can you get back to the panel? Case law will illustrate. Section 12 IME:  Big Company v. Small Companies
  11. 11. 1.1: Conduct (pg. 4)- Arbitrators/Commissions have standards4(a)2: Employee Leasing Company (pg. 10)- Add as additional named insured4(d): Penalties for No Insurance (pg. 12)4(b): Collective Bargaining Pilot Program (pg. 25)8(a): Employer to Pay Necessary Medical (pg.44)- Required even if accounts receivable transferred.8.2: Medical Fee Schedule- Reduced allowable charges.
  12. 12. 11: No Recovery for Injury Incurred During Certain Crimes (pg. 78)13 and 14: Arbitrators (pg. 82 + 87)- Licensed to practice law.- Formal training program.- 3 per hearing site.16(b): Gift Ban (pg. 95)- Nothing exceeding $75 per person/day- Class A Misdemeanor18.1: Claims By IWCC Workers (pg. 97)- Need certified independent Arbitrator
  13. 13. Borrowing/Loaning Employers:- 1(a)4: Admit or deny within 7 days.Jurisdiction:- 1(b)2: K made in IL, injury, principally located- 1(b)3: Exemptions: Real estate broker, Broker- salesman, salesman paid by commission only.Burden: Preponderance Of the Evidence: 1(b)3(d)Automatic Coverage:- Section 3 (1-20)Non-Compliance:- 4(d): Employer not entitled to protection of Act when not maintaining insurance.- Injured Workers’ Benefit Fund – Pro rata share
  14. 14. Illegally Employed Minors:- 5(a) and 7(h): 6 month reject Act.  Civil case- 50% increase in compensation under Act.Subrogation:- 5(b): Need consent of employer to waive lien.Workplace Notice:- Must post printed notices of insurance (handbook?)Firefighter/EMT/Paramedic:- 6(f): Rebuttable presumption of sicknesses if worked over 5 years
  15. 15. Death Cases:- 7: Must show dependency, Second Injury Fund and Rate Adjustment FundCredits on Body Parts:- 8(e)17: deductions from subsequent injuries.Group Health Insurance:- 8(j): Hold harmlessBalance Billing:- 8.2(e): Prohibited. Collection efforts tolled.Recreational Situations:- 11: Voluntary: no recovery.
  16. 16. IMEs: 12:- Reimbursement/Mileage- Right to medical practitionerSubpoenas:- 16: Rebuttable presumption of accuracy if certified.19(b) Hearings:- Must have 12 weeks TTD in controversy.NO LIENS:- Section 21.
  17. 17. IWCC:- Worker’s Compensation Act:- Provider Programs:-