Recently, the Governor signed legislation, which made several important changes to the Illinois Workers' Compensation Act. Given these changes, it is now more important than ever that you have experienced attorneys representing your interests after a work injury.
One of the most important changes involves the injured worker's choice of doctor. The new amendments to the Act allow employers to establish Preferred Provider Programs (PPPs) and changes the way employees are allowed to choose their treating medical providers. Formerly, the employer was responsible for all first aid and emergency services, two treating doctors of the employee's choice and any additional providers to which the employee is referred by the two treating doctors. However, under the newly amended Act:
- The number of treating physicians allowed depends on whether the employer is enrolled in a Preferred Provider Program, or PPP. A PPP establishes a group of doctors and medical providers that have been approved by a particular employer to treat its workers.
- If the employer is not enrolled in a PPP, an injured worker will have the right to seek medical treatment from up to two doctors of his choosing and any medical providers he is referred to by those two doctors.
- However, if the employer is enrolled in a PPP, an injured worker must decide to "opt in" or "opt out" of the employer's PPP. If the employee opts in to the program, he can seek treatment from up to two of the listed medical providers and any providers he is referred to by the two chosen providers. If the commission finds that the second choice of doctor within the employer's PPP network has not provided adequate treatment, the employee may then choose a doctor from outside the network.
- If, on the other hand, the employee opts out of the program, he is limited to only one doctor of his choosing and any providers he is referred to by that doctor. In essence, the choice to opt out of the program will be considered one of the employee's two "choices" of doctor.
- Note: Emergency first aid is not considered one of the employee's choices of doctors. However, if, before reporting an injury, an employee receives non-emergency treatment by a doctor who is not on the employer's PPP list, this will be considered the employee's one choice of doctor and the employee will not be allowed another.
- If an employee wants to see a third doctor, he or she may do so at his or her own expense. The employer may approve a third doctor but is not obligated to pay for the treatment.
Some of the other changes to the Act include:
- Shortening the term of the Arbitrators who preside over Workers' Compensation cases;
- Codifies that an employee has the burden of proving that his injuries arose out of his employment or occurred in the course of his employment;
- Allows for the use of the most recent American Medical Association guidelines in impairment when making determinations regarding permanent disability (PPD).
- Changes the way compensation is calculated for workers who are injured while intoxicated.
- Makes Arbitrators and Commissioners subject to the same Code of Judicial Conduct as state court judges.
- Requires that all new Arbitrators must be licensed to practice law in Illinois and must keep that status current throughout their terms as Arbitrators.
- Requires increased training for Arbitrators regarding professional and ethical standards.
- Caps awards for carpal tunnel syndrome at 15% unless the employee proves a greater level of disability by clear and convincing evidence.
- Reduces the amount of medical expenses for which the employer is liable according to the medical fee schedule.
- Changes some penalties for workers' compensation fraud by employees or employers.
- Requires increased annual reporting to state agencies regarding all aspects of Illinois Workers Compensation.