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Making Change Work: Utilization Review

Changes to one cost containment measure in 2011, Utilization Review, "UR", reflected Springfield's ongoing intent that health care providers treat reasonably. To name just one undesirable result of excessive care, its billing can make cases impossible to settle. One workers' compensation insurance carrier, Country Insurance and Financial Services, convinced that extensive care had obstructed enough negotiations, determined to innovatively apply UR.

Working with Brady, Connolly & Masuda, P.C., Country formulated an approach allowing settlement of the Comp case leaving bills for unreasonable care unpaid. As part of the accord, Country agreed to protect the injured worker if he was sued by the provider post contract approval and to afford a defense.

Two such settlements have resulted in civil lawsuits requiring County to step in for the worker. In the first, involving a claim for over $100,000.00 in fee bills, the providers have, at least at this point, dropped their attempt to collect from the worker, and in fact have voluntarily dismissed their lawsuit. The second involved a great deal less in fees but resulted in an actual hearing under the Mandatory Arbitration procedures of the Circuit Court of Cook County. After listening to the testimony of numerous witnesses, including the injured worker and personnel from the provider, the panel awarded the providers nothing, finding entirely in favor of the injured worker (and, of course, through him for Country).

Making Change Work: AMA Standards

In an effort to reduce costs to business and ensure predictability in permanent disability awards, the Illinois Legislature in 2011 required the Commission to consider five factors in determining permanent disability:

  1. impairment rating pursuant to the 6th Edition of the American Medical Association guidelines;
  2. the occupation of the employee;
  3. the age of the employee at the time of the accident;
  4. the employee's future earning capacity; and
  5. evidence of disability corroborated by the treating medical records.

The Commission was cautioned that "no single enumerated factor shall be the sole determinant of disability." While the Commission is tasked with considering the evidence introduced on each factor, there are some trends developing on which weighs heaviest.

Closing Files

April 2013

By Francis M. Brady

"This file has been open for six years!"

"I had this case as an adjuster and now I have it back again as a supervisor!"

"Isn't there some way to get this file heard!"

If you are doing business in Illinois, or representing those who are, you likely have heard similar sentiments, or even expressed them yourself. Illinois employers and those of us who assist them, come into contact frequently with the Illinois Workers' Compensation Commission (IWCC). The IWCC system does not universally lend itself to the expeditious disposition of litigation.

This article considers one way to overcome institutional inertia.

The age of the case at the IWCC often not does match the age of the file in your claim drawer. A lengthy period of time can elapse between the accident and the date the worker files his case. As a general rule, an injured worker has three years from his accident to file with the IWCC. Even then, petitioner is under no compulsion to press his case for another three years.

Pro Se Settlement Procedure From Chairman Weisz

From Chairman Weisz:

I understand that as a matter of accommodation, settlement contracts on pro se matters are routinely approved by Arbitrators before being assigned a case number. Our research indicates this happened over 3,500 times in Calendar Year 2010.

The Commission is extremely sensitive to the needs and desires of injured employees and businesses to get files approved and closed quickly; however, the present system does not allow us with a way to determine if any of those contracts go astray and fail to get entered into the system.

Chairman Ruth Resigns

October 3, 2008

Dennis R. Ruth has resigned as Chairman of the Illinois Workers' Compensation Commission effective the close of business on October 2, 2008. Governor Blagojevich appointed Gerald Jutila to replace Chairman Ruth effective today, October 3, 2008. Arbitrator Laramie will assume responsibility for the cases on Arbitrator (now Chairman) Jutilas call for the rest of 2008. But, in 2009, Arbitrator Dollison will replace Arbitrator Lammie who will, per the website, return to other duties.

Before leaving office, Chairman Ruth changed various assignments to equalize caseloads and minimize travel. You'll find attached a list of the changes that include Arbitrator Akemann taking over the lions share of cases in Rockford, with Arbitrator Giordano departing from that venue to handle the entirety of Kankakee and Ottawa. Arbitrator Andros is vacating Ottawa and Woodstock to take over DeKalb and to help in Rockford and Waukegan. Arbitrator Erbacci is transferred from Waukegan to handle all of Woodstock and a portion of Wheaton. Arbitrator Fratianni is taken from Wheaton and transferred to Waukegan where she will handle most of the cases.

Other changes of note concern Arbitrator Mathis who will be handling all of Peoria, while Arbitrator Neal is shifted to Carlinville, Decatur and Urbana. Arbitrator White will take over in Bloomington and Mattoon, with Arbitrator Falcioni moving to Joliet where he will handle the majority of the call, while Arbitrator Hennessy joins Arbitrator Kinnaman in Geneva. Arbitrator Tobin assumes the Springfield call, with Taylorville and Carlyle being eliminated. Cases assigned to those venues will be transferred to the closest hearing site.

Expanding the Fee Schedule?

October 3, 2008

Consideration is under way to include ambulatory surgical treatment centers; hospital outpatient radiology, pathology and laboratory, physical medicine and rehabilitation services; hospital outpatient surgical facility services; and rehabilitation hospitals in the fee schedule. Currently, bills from these facilities must be satisfied at up to 76% of actual charge.

Setting specific fees for these providers, according to geozips, was apparently first considered earlier this year. Hearings were held where public comment was taken and written comments were accepted until late April of 2008. Specific fees for particular services and providers are listed at the Illinois Workers' Compensation Commission website according to geozips.

Note, however, that the proposal to bring these various providers within the operation of the fee schedule remains somewhat uncertain, The proposed rules must be approved by the Joint Committee on Administrative Rules and thereafter filed with the Secretary of State. The Commission anticipates that this will be done by December 1, 2008 but, currently, the changes are not in effect.

  • Chicago Bar Association
  • Workers' Compensation Lawyers Association
  • IRTB
  • DRI - The Voice of the Defense Bar
  • The Illinois Association of Defense Trial Counsel
  • Illinois Self-Insurers' Association
  • Chicago Bar Association
  • Workers' Compensation Lawyers Association
  • IRTB
  • DRI - The Voice of the Defense Bar
  • The Illinois Association of Defense Trial Counsel
  • Illinois Self-Insurers' Association
10 South LaSalle Street, Suite 900
Chicago, IL 60603
Phone: 312-425-3131
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Normal, IL 61761
Phone: 309-862-4914
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St. Louis, MO 63102
Phone: 314-300-0527
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