By Fadi B. Rustom, partner at Hall & Rustom, LLC
What are the main changes in 2011 to Illinois Worker’s Compensation Laws?
The two biggest changes under the 2011 Illinois Workers Comp Reforms are
1) Reduction of the Medical Fee Schedule rates by 30%; and
2) The introduction of employer Preferred Provider Programs plans approved by the IL Dept of Insurance that attempt to limit the employer’s liability for medical treatment.
The injured worker can only “Opt-Out” of the employer’s PPP plan in writing and before exhausting their 2 choices of doctor in network. After using up 2 choices of physicians within the PPP network, the injured worker can only request a hearing at the Commission for a finding on the “adequacy of care” to see if they are allowed to go out of network.
The not so obvious medical treatment options following the new reforms are:
(1) if the employer has no PPP provider, the employee retains the right to choose 2 doctors;
(2) if the employer has an Illinois workers comp PPP plan and notifies the injured employee of the PPP plan in writing, soon after receiving the report of injury, injury treatment options are limited to the PPP plan or;
(3) if the employee declines the PPP and Opts-out (in writing) before treating with the PPP plan, the worker automatically loses 1 choice of doctor and has only 1 choice of doctor left to go outside of network;
(4) if the employee “opts out” (in writing) after initial treatment by a PPP plan doctor, they also have only 1 choice of doctor left to go outside of network;
(5) if the employee stays in network and uses up both choices of doctor in network, they have no doctor choices left — they can only go outside of network upon a hearing at the Commission and after a finding of “improper or inadequate” medical care.
Official Language for Notification to Employees of Employer Selected PPP
The Illinois Workers Compensation Commission has approved the official language to be used to notify injured employees of employer selected “Preferred Provider Programs” (PPP) that is, employer selected medical networks for work injury related medical care. (ATTACHED FOR YOUR REVIEW) This is the official form language to be used to notify the injured employee of the employer’s selection of their medical provider network as soon as the employer is made aware of the work injury.
Employers can voluntarily issue an advance notice of workers comp medical network (ATTACHED FOR YOUR REVIEW) by using the additional form language provided. However, even if the advanced general notice of workers comp medical network is posted or given to all employees, the above official Notice of Workers Comp Medical Provider (PPP) must still be issued in a timely manner soon after the employer receives notice of an actual work accident or work injury.
These PPP networks must still be approved by the IL Dept of Insurance and approvals are expected for use by Jan 1, 2012. The Illinois Department of Insurance is currently accepting Preferred Provider Program applications for approval and as the process unfolds, the approved list of “Preferred Providers” will be available on their website.
Other 2011 Changes to Worker’s Compensation Act
The Amendment to Section 8.1(b) of the Illinois Workers’ Compensation Act delineates the determination of permanent partial disability. For all accidents occurring on or after September 1, 2011, permanent partial disability shall be established by a licensed physician reporting on the level of impairment in writing.
The Amendment to Section 8(e)(9) the Illinois Workers’ Compensation Act specifically delineates hand injuries involving carpal tunnel syndrome due to repetitive or cumulative trauma be returned to their pre-2005 scheduled amount of 190 weeks, and places a disability limit of 15% loss of use of the hand in such cases, unless clear and convincing evidence can show an award should exceed this amount. In such cases the award should not exceed 30% loss of use of the hand.
The Amendment to Section 8(d)(1) of the Illinois Workers’ Compensation Act confirms any award for wage differential for accidents occurring after September 1, 2011 shall be effective only until the employee reaches the age of 67 or five years from the date the award becomes final, whichever is later.
The Amendment to Section 11 of the Illinois Workers’ Compensation Act provides an intoxication defense; however, this was greatly limited. The new section confirms no compensation shall be payable if an employee’s intoxication is the proximate cause of the employee’s accidental injury at the time of the accident, or if the employee was so intoxicated the intoxication constituted a departure from the employment.
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