Workers' Compensation

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 provide guidance and 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've been injured on the job.

For decades, workers’ compensation insurers have been using “cost saving strategies” on the backs of doctors by routinely holding back reimbursement for medical care for months – even years! This abuse of the workers’ comp system has placed an extreme burden on medical practices. Governor Rauner and the business community continually pushed for more cuts to the medical fee schedule during his term. The Illinois State Medical Society (ISMS) successfully pushed back against those cuts ISMS has been actively working to reform these harmful tactics, which ultimately cause problems for patients in accessing care.

In 2018, ISMS successfully backed legislation to amend the Illinois Workers’ Compensation Act to require the payment of interest for delayed reimbursement. However, the government failed to enforce the requirement due to regulatory ambiguity. ISMS successfully acted in 2018 to pass legislation to clean up the regulations.

The 2018 workers’ compensation law made three important changes:

  • Allows medical professionals to collect interest on late medical claims by filing a claim for this interest in circuit court, and increase that late payment penalty from 1 percent to 2 percent.
  • Requires workers' compensation insurance companies to send an Explanation of Benefits to medical professionals explaining why they have denied the authorization of medical care or what additional information they need to make a decision on that care.
  • Prevents workers' compensation insurers from ignoring the law requiring them to use electronic billing for workers' compensation claims. This has been the law for seven years, yet workers' compensation insurers still refuse to use standardized electronic billing systems that are used throughout the rest of the healthcare world.

ISMS continues to monitor the workers’ comp system to ensure fair reimbursement for medical practices and greater access to care for Illinois patients.

To see ISMS’ specific work on workers’ compensation related issues, please check out the end of session legislative reports.

Currently Tracked Bills

ISMS Opposes

Workers’ Compensation Medical Fee Schedule HB3559 (Sponsors: Rep. Dan Ugaste) This bill amends the Workers’ Compensation Act to abolish the existing medical fee schedules after August 31, 2022, and establishes new medical fee schedules applicable on and after September 1, 2022 in accordance with specified criteria. It creates four non-hospital fee schedules and 14 hospital fee schedules, applicable to different geographic areas of the State. It also sets forth a procedure for petitioning the Commission if a maximum fee causes a significant limitation on access to quality health care in either a specific field of health care services or a specific geographic limitation on access to health care. This bill failed to advance.

Compound Drugs 7-Day Supply HB3560 (Sponsors: Rep. Dan Ugaste) - This bill amends the Workers' Compensation Act regarding unique medications that are compounded in a physician’s office, and sets forth conditions for approval of payment for said medications. It also provides that charges shall be based upon the specific amount of each component drug and its original manufacturer's National Drug Code number and also upon specified criteria. And it limits prescriptions of compounded drugs to a one-time 7-day supply unless a prescription for more than 7 days is preauthorized by the employer. This bill failed to advance.

Related Resources

Successfully Navigating the Illinois Workers' Compensation System
Successfully Navigating the Illinois Workers' Compensation System
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