The state of Illinois has taken a series of steps to cut employers’ workers’ compensation costs. The following reforms took effect Sept. 1:
• Fee schedule amounts (those amounts required by treating physicians, insurance carriers or self-insured employers) will be reduced by 30% across the board. State officials say the move will save Illinois employers up to $500 million.
• The state has adopted standards related to the assessment of physical impairment and total-body disability set by the American Medical Association. Physicians and arbitrators must now follow those standards when analyzing an injured worker’s post-injury physical condition.
• Wage-differential benefits will pay out for only five years, or until the injured worker is 67, whichever is later. Previously, those benefits were paid out for life.
• Carpal tunnel syndrome claims, one of the most common and costly workers’ compensation claims, are now capped at 15% loss of use of the hand, except where there is “clear and convincing evidence” that the employee has suffered a more significant loss. In any case, the claims cannot exceed 30% of total loss.
• Employers can now create their own preferred-provider organization (PPO) programs to handle workers’ compensation claims, and employees must seek treatment from in-network providers when such programs are offered. There’s an exception for employees who can prove that care given by in-network providers is or would be insufficient.
• Claims from employees injured while intoxicated will be denied. Specifically, an injured worker will not be entitled to compensation if his or her intoxication was the proximate cause of the injury or the injured worker was so intoxicated that his or her condition constituted a departure from his or her employment.
• Utilization-review procedures and requirements will be clarified and more strictly applied. However, the state will still consider a valid and otherwise admissible utilization review, if any, when determining the reasonableness and necessity of an employee’s treatment.
Employers should consult with their workers’ comp carriers to ensure workplace injury reporting procedures and posted notices are up-to-date and comply with the new law.
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