Governor Pat Quinn signed a new law amending Illinois’s workers’ compensation law last Tuesday that he hopes will reduce employers’ insurance premiums and help Illinois retain and attract businesses concerned with the state’s insurance costs. Governor Quinn estimates that the changes will save employers at least $500 million on the estimated $3 billion in costs they pay each year the Chicago Tribune reports.
Illinois has some of the higher workers’ compensation premiums in the country. The new law aims to reduce these costs in order to attract new businesses and jobs to the state as well as retain those already here. “This overhaul is going to improve the strength of our state’s business climate and economy,” Governor Quinn said. “We’re going to be helping employers in Illinois, workers in Illinois, all of those who are committed to economic growth.”
However, much of these changes come at the expense of Illinois workers, and there is no guarantee that insurance companies will pass along these savings in the form of lower premiums.
One of the major changes is a 30% reduction in the current fee schedule for doctors and hospitals that treat employees under workers’ compensation. In theory, this change will make the cost of treating workers cheaper, and therefore lower business’s premiums. Nothing mandates the lowering of premiums, however, and the people of Illinois must trust insurance companies to pass these savings along as the quality of their healthcare potentially suffers. Good physicians are at a premium, and a 30% reduction in their fee may cause many of them to stop treating injured workers.
The fee reduction is in conjunction with the creation of employer PPO networks for injured workers. Currently, when a worker is injured, they are able to seek out two doctors of their choice. After the law goes into effect, employees of businesses who opt-in to the PPO plans will only be able to choose from two doctors within that network and seek a hearing to go out of network if they are not satisfied with their first two selections. Workers may also “opt-out” of the plan in writing, but they then only have one choice of doctor, according to the Beacon News. Under the old law, workers could choose two physicians. Once again, Illinois workers are being asked to sacrifice their quality of healthcare for the benefit of Illinois businesses in general.
Currently, when a worker is injured and forced to take a lower paying job because they cannot return to the old, the worker is entitled to two-thirds of the difference between the new and old wages for the rest of their life. After the changes go into effect, these wage differential cases will only pay workers this difference for 5 years after the incident or until they reach the age of 67, whichever is later. This is a significant disadvantage to older workers. Not all Illinois residents can retire on time or even at all in this economy.
The extent of permanent partial disabilities will now be judged according to the American Medical Association’s Guides to the Evaluation of Permanent Impairment. Currently, the compensation is set by an arbitrator based on their own judgment, past precedent, and the testimony of the workers themselves. After September 1st, a physician will evaluate an injured worker based on the AMA’s guide to determine the measure of impairment and level of function lost due to the injury. This will then be submitted to the arbitrator. This policy is meant to increase the accuracy and fairness of disability assessments by moving to a more objective approach.
The arbitrators themselves will also change under the new law, according to the Illinois Government News Network. The current arbitrators’ terms end on July 1 and will be subject to strict evaluations in their consideration of re-appointment. Any new arbitrators must be licensed attorneys and all arbitrators will receive ongoing training in fraud, ethics, and medical practices.
The Department of Insurance will now file a report each year that analyzes the workers’ compensation insurance market. This is mean to provide oversight of the industry and make sure the system is not being abused by insurers or workers. This is an extremely important part of the legislation. Illinois workers cannot rely on the insurance companies themselves to pass along the savings after they have sacrificed so much. Hopefully this report will be a means to keep insurance companies honest in their practices and not be a toothless report that does nothing but cost taxpayers money.
Still, many politicians and business leaders are still upset that this law doesn’t do enough to curb costs in the system, CBS News reports. The main contention is that the bill does not change the causation requirement in a claim. Currently, work need only be a cause of the injury rather than the primary cause of the injury. Proponents of new causation requirements maintain that the reform is necessary to lower business’s premiums and end pervasive fraud within the system.
This change would make it extremely burdensome for legitimately injured workers to prove their injury claim. If a worker can’t point to a specific instance of when the injury occurred, and it is not typical of the industry, they may be denied compensation they deserve. Workers’ compensation claims are already highly-scrutinized, and an increase in the burden of proof would surely result in the denials of legitimate claims Illinois workers depend on for their livelihood.
Rooting out fraud is a high priority for insurance companies, business owners, and Illinois workers alike. It is in all parties’ best interest to eliminate these fraudulent claims and make health care more affordable for those who need it. Earlier this year, the Chicago Sun-Times reported that federal investigators had begun a criminal investigation into workers’ compensation claims by government employees. At the center of the investigation is the $10 million in claims paid out to 389 Menard Correctional Center employees since 2008, including 230 who claimed repetitive-stress injuries from locking and unlocking cells doors. Menard was the only prison to report such a high volume of these injuries. The investigation also includes three arbitrators involved in the claims.
This alleged fraud did not occur because of Illinois’ causation standards, it occurred because of the abuses by some specific individuals. Illinois needs to worry about finding the few people who take advantage of the system without requiring hard-working Illinois citizens to further sacrifice their benefits.
The new law is the most significant change to Illinois’ workers’ compensation system in decades. Illinois workers need to understand their rights to make sure they are receiving the maximum possible benefit owed to them to compensate for their work-related injury. It is becoming more and more difficult to make legitimate workers’ compensation claims, and seeking legal counsel is even more imperative than before.
If you have been injured on the job, contact an Illinois work injury lawyer at our office for a free case evaluation. Call 312-924-7575 to speak directly to an attorney now.
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This blog was co-authored by Shane Nichols, a second-year law student at the John Marshall Law School in Chicago.