Work Comp Chicago Illinois Workers Compensation Attorneys
Illinois Workers Compensation Resource Links
We have found many of the following links to be useful in Illinois workers compensation.
A wealth of information concerning all aspects of Illinois workers compensation. Rules, regulations, benefit rates, medical fee schedules, contact information and hearing locations. General information: tel :(312) 814-6611 toll free: (866) 352-3033
Illinois law requires employers to obtain workers' compensation insurance. If an employer knowingly and willfully fails to obtain insurance, it may be fined up to $500 for every day of noncompliance, with a minimum fine of $10,000. Corporate officers can be held personally liable if the company fails to pay the penalty. Corporate officers who are found to have negligently failed to obtain insurance are guilty of a Class A misdemeanor; if they are found to have knowingly failed to obtain insurance, they are guilty of a Class 4 felony. An employer that knowingly fails to obtain insurance can be sued in civil court, where benefits are unlimited.
Insurance Coverage Search page provides insurance coverage information from policy information reported to the Illinois Workers' Compensation Commission (IWCC) through the National Council on Compensation Insurance (NCCI).
When the Commission collects penalties and fines from uninsured employers, it deposits these monies into the Injured Workers’ Benefit Fund (created in the 2005 amendments), which then pays workers’ compensation benefits to injured employees whose uninsured employers fail to pay a final award. See details for qualifications
The Illinois Workers' Compensation Commission Medical Fee Schedule and the payment guidelines were adopted as a statewide Workers Compensation Medical Fee Schedule broken down by state zip code. The maximum allowable payment for a particular medical procedure, treatment or service covered under the Workers Compensation Act is now set based on historical charges for all locations throughout the state from 2002 to 2004, cost adjusted for inflation. Historical charges were analyzed and broken down by the 3 number geozip or 1st three numbers of a zipcode, i.e., 606-- for Chicago. Generally, the reimbursement rates are set at 90% of the 80th percentile of actual historical charges for a specific area zip code.
The new fee schedule amendment covers all medical care rendered on or after February 1, 2006. The medical fee schedule sets forth caps or maximum limits for payment of medical invoices based on particular medical procedure code, the date of service and the location (or zip code) where the medical care is rendered. The amount payable to the provider under the fee schedule is set out as the lesser of the Fee Schedule amount, the actual billing charge or a controlling "negotiated rate" as established by a negotiated provider contract with the actual medical provider. An established contract will control over the amounts set forth in the schedule.
Inpatient Hospital charges and Physician Professional charges are listed in specific amounts in the fee schedule. Special rules will apply for add-on or pass through charges for hardware, instrumentation and medical devices.
Current Illinois maximum disability benefit rates schedule. Every six months, the Illinois Department of Employment Security publishes the current statewide average weekly wage which is used as a baseline to set the maximum and minimum disability benefit rate levels for all workers' compensation benefits including temporary total disability or claimed permanent disability rates
The Rate Adjustment Fund pays cost-of-living increases to claimants who are permanently and totally disabled or to death beneficiaries who are the survivors of fatally injured workers. Cost of living increases are based on the increase in the statewide average weekly wage.
The assessment is 1.25% of all workers compensation payments made in the preceding 6 months excluding medical payments. Payment is due March 15 and September 15. If an employer fails to make timely payment, the Commission may impose a penalty equal to 20% of the amount due or $2,500, whichever is greater.
The Second Injury Fund provides benefits for workers where there has been a previous complete loss of one hand, one arm, foot, leg, or eye and where the workers is subsequently injured in a new 2nd accident and again suffers the complete loss of another hand, arm, foot, leg, or eye. The worker in the 2nd accident is entitled to statutory permanent and total disability benefits. The employer in the 2nd accident is only liable for the complete loss of the 2nd hand, arm, foot, leg, or eye occasioned by the second accident. The Second Injury Fund pays the permanent and total disability benefits.
Insurers and self-insured employers pay assessments up to 1/8 of 1% of compensation payments, excluding medical expense payments, for all payments of compensation made in the preceding 6month period.
Questions regarding payments contact Maria Sarli-Dehlin, IWCC Self-Insurance Division, at 312/814-6065 or questions regarding benefits contact Inez Gardner, IWCC Fiscal Office, 312/814-1446
Medicare as a Secondary Payer and Workers' Compensation
Pursuant to 42 U.S.C. §1395y(b)(2) and § 1862(b)(2)(A)(ii) of the Social Security Act, Medicare is precluded from paying for a beneficiary's medical expenses when payment "has been made or can reasonably be expected to be made under a workers' compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance."
Federal law (42 U.S.C. § 1395y(b)) not only establishes that Medicare is a secondary payer to WC, but also that Medicare has a priority right of recovery over any other entity to the proceeds of any settlement. To the extent that Medicare has made any "conditional payments", Medicare will recover those payments pursuant to 42 C.F.R. § 411.47.
Pursuant to 42 C.F.R. § 411.21, "conditional payments" are payments by Medicare for services for which another payer is actually responsible, made either on the basis set forth in 42 C.F.R. § 411 subparts C through H, or because the intermediary or carrier did not know that the other coverage existed.
Medicare Set Asides: Future Medical in Illinois Workers Comp SettlementsThe burden of future medical expenses in WC cases may not be intentionally shifted over to Medicare. 42 C.F.R. § 411.46 and § 411.47 provide that Medicare's interest must be considered in WC settlements whenever future medical expenses are a component of the settlement.
Medicare does not pay for any WC related medical services when the worker receives a settlement that includes money for future medical expenses or money for closing out future medical rights. It is in the best interest of all parties to consider Medicare's future interests at the time of settlement and allocate or state a dollar figure for future medical expense in the settlement contracts. CMS recommends parties to a WC settlement set aside money in a separate interest bearing account, known as a Workers' Compensation Medicare Set-aside Arrangements (WCMSAs). The account should funded for all expected future medical care related to the WC injury that would otherwise be payable by Medicare.
If Medicare's interests are not considered, CMS has a priority right of recovery against any entity that received a portion of a third party payment either directly or indirectly. If there is no allocation, Medicare may refuse to pay any medical expenses that are related to the WC injury until the entire settlement has been exhausted. Prior CMS review of proposed future medical fund accounts can be obtained in advance of the WC settlement or following the work comp settlement to guarantee CMS' approval of the sufficiency of the future medical account.
All WCMSA proposals submitted for CMS review must be sent to:
CMS
c/o Coordination of Benefits Contractor
P.O. Box 33849
Detroit, Michigan 48232-5849
Attention: WCMSA Proposal
Summary of CMS MEMOS on Workers Compensation Medicare Set Asides (pdf downloads) This summary is not all inclusive but only a reference point for CMS memos issued regarding WCMSA arrangements. Only a complete review of all the CMS Memos and consultation with a WCMSA expert will give you a fairly accurate prediction of an anticipated Medicare response.
July 23, 2001 Memo (PDF)"Workers' Compensation: Commutation of Future Benefits" the "Patel Memo" is too long to summarize here and too often contradicted by subsequent CMS MEMOS.
April 21, 2003 Memo (PDF) Detailed list of documents for WC Medicare set-aside approval and MSA exceptions.
MSA EXCEPTION: According to CMS, it is unnecessary to establish a WCMSA set-aside arrangement if all of the following are true:
a) The facts of the case demonstrate that the injured individual is only being compensated for past medical expenses (i.e., for services furnished prior to the settlement);
b) There is no evidence that the individual is attempting to maximize the other aspects of the settlement (e.g., the lost wages and disability portions of the settlement) to Medicare’s detriment; and
c) The individual's treating physicians conclude (in writing) that to a reasonable degree of medical certainty the individual will no longer require any Medicare-covered treatments related to the WC injury. (see Answer #20)
In cases that involve a WC claim and a 3rd party liability claim, CMS requires a WCMSA. To the extent that a liability settlement relieves a WC carrier from any future medical expenses, a CMS approved MSA is appropriate with sufficient funds to cover future medical expenses incurred once the total third party liability settlement is exhausted. The only exceptions to establishing a MSA would be if it can be documented that the beneficiary does not require any further WC claim related medical services or if the medical portion of the WC claim remains open and WC continues to be responsible for related services once the liability settlement is exhausted.
If a beneficiary or injured individual dies before the Medicare set-aside arrangement is completely exhausted, the remaining money may be disbursed pursuant to state law to the estate, once the Regional CMS Office and coordination contractor ensure that all of the beneficiary's Medicare claims have been paid and Medicare’s interests have been protected.
May 23, 2003 Memo (PDF) "Medicare Secondary Payer FAQs-- The controversial "Review Threshold" for Non Medicare Beneficiaries--
To the extent that a WC settlement meets both criteria (the settlement is greater than $250,000 AND the claimant is reasonably expected to become a Medicare beneficiary within 30 months of the settlement date), then a CMS-approved Medicare set-aside arrangement is appropriate. However, if a WC settlement is $250,000 or less OR the claimant is not reasonably expected to become a Medicare beneficiary within 30 months of the settlement date, then a CMS-approved Medicare set-aside arrangement is unnecessary. When an individual's settlement does not meet both thresholds, Medicare will make payment for WC related services that are otherwise reimbursable under Medicare once that individual enrolls in Medicare. (NOTE: CMS later changed their minds and this answer was REPLACED BY Q3 of the JULY 11, 2005 MEMO)
May 7, 2004 Memo (PDF) CMS new policy regarding administrative fees or attorneys fees in WCMSA cases. Administrative fees for administration or attorney's fees associated with establishing the Medicare set-aside arrangement cannot be charged to the set-aside arrangement. These costs must come from a separate payment source completely separate from the Medicare set-aside funds.
October 15, 2004 Memo (PDF) updated FAQ's. Fee Schedule amounts vs. Actual Charges: CMS’s review will use either the WC fee schedule amounts or full actual charges based upon whichever method was priced into the proposal. Important: administrators of the WCMSA should make payments on the same basis as priced into the MSA submission. If the proposal was approved based upon full actual charges, the administrator should make payment based upon full actual charges; if the proposal was approved based upon WC fee schedule amounts, the administrator should make payment from the WCMSA based upon WC fee schedule amounts.
The WCMSA does not need to be indexed for inflation and may not be discounted to present-day or present cash value. (This answer replaces some answers in the JULY 23, 2001 MEMO)
July 11, 2005 Memo (PDF) CMS issued updated FAQ's. Even if there exists no CMS-approved WCMSA because review thresholds were not met, any funds in a WC settlement allocated for future medical that are remaining at the time a claimant becomes a Medicare beneficiary must be used for Medicare-covered services that are related to the workers’ compensation claim until such funds are exhausted. Only then will CMS pay for Medicare-covered services related to the workers’ compensation claim or settlement. (This memo replaces some prior answers in JULY 23, 2001 MEMO and MAY 23, 2003 MEMO)
REDUCTIONS IN MSA ACCOUNTS: if the treating physician concludes that the beneficiary’s medical condition has substantially improved, then the beneficiary may submit a new MSA proposal covering future expected medical expenses. Such proposals must justify at least a 25% reduction in the outstanding WCMSA funds and amended MSA proposals may not be submitted until at least five years after a previous CMS approval letter.
COMPROMISE SETTLEMENTS: CMS will not compromise or reduce future medical expenses related to a WC injury. Submitters have argued that 42 C.F.R. §411.47 justifies reduction of the WCMSA amounts. CMS reads the "compromise language" in this regulation as only addressing conditional (past) Medicare payments. Accordingly, CMS does not allow for the compromise reduction of future medical expenses related to a WC injury.
December 30, 2005 Memo (PDF) new Part D drug coverage; Medicare Set-aside Arrangements (WCMSAs) received by CMS on or after January 1, 2006, must include amounts for both (1) future medical treatment, and (2) future prescription drug treatment.
(some of these instructions changed by the July 24, 2006 MEMO).
April 25, 2006 Memo, low dollar $25,000 review threshold. CMS will only review WCMSA proposals where the total settlement amount is greater than $25,000.00. This is a CMS workload
review threshold and not a “safe harbor”.
July 24, 2006 Memo regarding Part D: All WC settlements on or after January 1, 2006 must include prescription drugs along with future medical services otherwise reimbursable by Medicare.
May 20, 2008 Memo regarding life expectancy, CMS will use Table 1 for Total Population from the Center's for Disease Control
The Centers for Medicare & Medicaid Services (CMS) have consolidated all work related Medicare Secondary Payer (MSP) payment recovery for Auto, Workers Comp & Group Health plans into one Payment Recovery Center. The location provides payout information on conditional Medicare payments and coordinates recoveries. For specific Workers Compensation recovery coordination contact:
MSPRC WC
PO Box 33831
Detroit, MI 48232-5831
For Pay out and Recovery information Contact:
MSPRC website
tel: (866) 677-7220 or (866) 677-7294 (TTY/TDD) or fax: (734) 957-0998
Mandatory Insurer Reporting (MIR): Medicare Secondary Payer Reporting A new law known as Mandatory Insurer Reporting (MIR) effective January 1, 2008, will require all insurers to report insurance coverage or claim information for any Medicare beneficiaries to CMS for the purposes of coordination of benefits. Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (PL 110-173) amends the Medicare Secondary Payer (MSP) provisions of the Social Security Act (Section 1862(b) of the Social Security Act; 42 U.S.C. 1395y(b)) to provide for
mandatory reporting of insurance coverage for group health plans, liability insurance (including self-insurance), no-fault insurance, and workers' compensation.
The law imposes a reporting duty on carriers to report the identity of Medicare beneficiaries and coverage information to CMS for all those that are covered by "primary" plans like health insurance, or active claims under workers compensation or auto liability plans. On 8-1-08 CMS released a
Statement Summary listing Medicare mandatory reporting "data elements" which lists the required reporting details and reasons for implementing the requirements. Carriers must notify CMS if a known Medicare recipient has a claim or coverage. Fines for noncompliance are $1,000 /day.
Compliance dates: -- January 1, 2009 information reporting to start for group health plans -- July 1, 2009 reporting from liability insurance, no-fault insurance, and workers' compensation.
CMS will likely demand to be notified of all workers compensation settlements or all liability settlements for any Medicare beneficiaries so as to enforce the Secondary Payer Regulations, Medicare lien recovery rules and credits against future payments for any injury related medical expense.
Reporting requirements may also include (1) Nature of Injury, (2) Cause of Injury, (3) State of Venue, (4) ICD-9 primary diagnosis codes and (5) Specific Body Part involved. See the Statement Summary above for a detailed listing of data elements.
CMS offers a central webpage for summary information regarding the updated carrier reporting requirements, updated memos and
.pdf downloads. See:
Mandatory Medicare Insurance Reporting
Illinois State Bar Association
The ISBA provides a collection of Illinois resources and law links. The mission of ISBA Workers' Compensation Law Section is to promote improvement in the workers' compensation system and the administration of justice under Illinois Workers Compensation; to enhance the professional capabilities of lawyers; to make recommendations on proposed legislation; to conduct conferences and seminars on topics of importantance; and promote better communications between lawyers and the Industrial Commission.
Founded in 1874, The Chicago Bar Association is one of the oldest and most active metropolitan bar associations in the United States. The Association's voluntary membership of 22,000 consists largely of lawyers and judges from Cook County and the State of Illinois.
The purposes and objectives of the CBA are to establish and maintain the honor of the profession of the law and to promote the general welfare of the members and the public. The CBA Lawyer Referral Service makes referrals to private attorneys with experience in over 50 areas of law. (312) 554-2001
State of Illinois Web Site
State of Illinois government portal. If you are looking for information on Illinois or Illinois law and you do not know where else to go, this is a good starting point.
Illinois Supreme Court & Appellate Court Opinions
Visitors to this site can search Illinois Court opinions back to 1996. (read the Help page 1st) The Workers Compensation Appellate decisions below are decided by a special panel of Illinois Appellate Justices from accross the state who in addition to their other duties are specially appointed to resolve workers compensation cases for appeals from the Illinois Workers Compensation Commission.
The Department of Human Rights administers the Illinois Human Rights Act, which prohibits discrimination because of race, color, religion, sex, national origin, citizenship status (with regard to employment), ager, marital status, disability, physical or mental handicap
It is illegal for anyone—a worker, employer, insurance carrier or medical provider to intentionally do any of the following:
• Make a false claim for any w.c. benefits;
• Make a false statement in order to obtain or deny benefits;
• Make a false statement in order to prevent someone from filing a legitimate claim;
• Make a false certificate of insurance as proof of insurance;
• Make a false statement in order to obtain w.c. insurance at less than the proper rate;
• Make a false statement in order to obtain approval to self-insure or reduce the security required to self-insure;
• Make a false statement to the state’s fraud and noncompliance investigation staff in the course of an investigation;
• Help someone commit any of the crimes listed above;
• Move, destroy, or conceal assets so as to avoid payment of a claim.
A “statement” includes any writing, notice, proof of injury, or any medical bill, record, report, or test result. Anyone found guilty of any of these actions is guilty of a Class 4 felony, punishable by 1-3 years imprisonment and a $25,000 fine.
Illinois Workers Compensation Fraud Call Toll Free: (877) 923-8648
Discrimination against an employee by an employer, labor union or employment agency when applying for a job or while on the job because of race, color, sex, religion, national origin, age, or disability is prohibited. Complaints of discrimination are filed with with the U.S. Equal Employment Opportunity Commission (EEOC). All laws enforced by EEOC, (Title VII of the Civil Rights Act (Title VII), Americans with Disabilities Act (ADA), and Age Discrimination in Employment Act (ADEA), except the Equal Pay Act (EPA), require filing a charge with EEOC before a private lawsuit may be filed in court.
The mission of the Illinois Department of Labor is to promote and protect the rights, wages, welfare, working conditions, safety and health of Illinois workers through enforcement of the state labor laws, and to ensure compliance with all other labor standards.
The Illinois Department of Labor establishes when, where and how often wages must be paid. They prohibit unilateral deductions from wages or final compensation without the employee's direct consent. The department provides assistance in the collection of wages and final compensation including any vacation pay, commissions, bonuses or benefits claimed due. Illinois state and federal government employees are exempt.
The Prevailing Wage Act requires contractors and subcontractors to pay laborers, workers and mechanics employed on PUBLIC WORKS construction projects no less than the general prevailing rate of wages (consisting of hourly cash wages plus fringe benefits) for work of a similar character in the county where the work is performed.
Individuals performing services for construction contractors on or after January 1, 2008 are presumed to be employees of the contractor unless they meet the criteria specified in Section 10 of the Act. If a contractor misclassified individuals as independent contractors, the Department may assess civil penalties and seek other remedies. The Department must notify the Department of Employment Security, the Department of Revenue and the Workers’ Compensation Commission who are then required to check such contractor’s compliance with their respective laws. Employee Classification Information Contact #: (217) 782-1710
The Occupational Safety and Health Administration aims to ensure employee safety and health in the United States by working with employers and employees to create better working environments. Since its inception in 1971, OSHA has helped to cut workplace fatalities by more than 60 percent and occupational injury and illness rates by 40 percent.
Regional Office
230 South Dearborn Street, Room 3244
Chicago, Illinois 60604
(312) 353-2220
In case of emergency call 1-800-321-OSHA
OSHA's On-Site Consultation Service offers free and confidential advice to small and medium-sized businesses in all states across the country, with priority given to high-hazard worksites. Consultation services are totally separate from enforcement and do not result in penalties or citations. Using a free consultation services, employers can find out about potential hazards at their worksites, improve their occupational safety and health management systems, and even qualify for a one-year exemption from routine OSHA inspections.
(c) 2008
Work Comp Chicago Illinois Workers Compensation Attorneys