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Illinois Workers' Compensation Commission (IWCC)

  • Illinois' workers compensation system is a complex and sometimes convoluted health delivery payment model for physicians. The Illinois Workers' Compensation Act protects Illinois workers by providing guidance and the minimum standards for physicians, employers, insurers and other interested parties to follow regarding the coverage of and payment for work-related injuries. The Act also sets guidelines for physician and facility payments from insurance companies following the treatment of workers who have been injured on the job.

    NEW! Evaluation of permanent impairment

    The American Medical Association (AMA) supports the use of the most current medicine to perform fair and consistent permanent impairment evaluations. The AMA Guides to the Evaluation of Permanent Impairment, 6th Edition is currently available and is considered the most current version as of July 1, 2021. The Illinois Workers’ Compensation Act states that physicians preparing a permanent partial disability impairment report shall use “the most current edition” of the Guides in determining the level of impairment.

    Background

    In 2011, the Illinois workers' compensation system underwent drastic changes which included a 30% reduction in the fee schedule. The physician procedures affected the most by the reduction were evaluation and management services. Another result of workers' compensation reform includes that physicians are now only able to collect up to 25% over the manufacturers' retail prices less rebates for implants, which many physicians understand to be different that the actual prices paid to the distributors. A cap was also added to percentage of charge for unlisted services formerly paid at 76% and now adjusted to pay at 53.2% post reform. While many Illinois workers' compensation claims are paid according to commercial contracts, the new regulations limited patient choice of physician to only those within a particular PPO network.

    Concerns continue to be expressed by Illinois physicians on several key matters for which they feel legislative emphasis should be placed in the coming years. The Illinois State Medical Society will continue to be a staunch advocate for physicians' abilities to treat and receive payments for services in a most conducive manner.

    Resources

    For information on current legislative initiatives and details on the Illinois workers' compensation system, please see the following resources:

  • If you are an ISMS member and have questions or need assistance, please contact the ISMS Division of Member Advocacy at  800-782-4767 or advocacy@isms.org.



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