By Fadi B. Rustom, partner at Hall & Rustom, LLC
The not so obvious medical treatment options following the new reforms are:
(1) if the employer has no PPP provider, the employee retains the right to choose 2 doctors;
(2) if the employer has an Illinois workers comp PPP plan and notifies the injured employee of the PPP plan in writing, soon after receiving the report of injury, injury treatment options are limited to the PPP plan or;
(3) if the employee declines the PPP and Opts-out (in writing) before treating with the PPP plan, the worker automatically loses 1 choice of doctor and has only 1 choice of doctor left to go outside of network;
(4) if the employee "opts out" (in writing) after initial treatment by a PPP plan doctor, they also have only 1 choice of doctor left to go outside of network;
(5) if the employee stays in network and uses up both choices of doctor in network, they have no doctor choices left -- they can only go outside of network upon a hearing at the Commission and after a finding of "improper or inadequate" medical care.
Employers can voluntarily issue an advance notice of workers comp medical network (ATTACHED FOR YOUR REVIEW) by using the additional form language provided. However, even if the advanced general notice of workers comp medical network is posted or given to all employees, the above official Notice of Workers Comp Medical Provider (PPP) must still be issued in a timely manner soon after the employer receives notice of an actual work accident or work injury.
These PPP networks must still be approved by the IL Dept of Insurance and approvals are expected for use by Jan 1, 2012. The Illinois Department of Insurance is currently accepting Preferred Provider Program applications for approval and as the process unfolds, the approved list of "Preferred Providers" will be available on their website.
If you have further questions, please visit our website at www.centralillinoislawyers.com and complete our online submission form. Or, you can call our office at 309-699-4691 or email us at how@howlawfirm.com.
LEGAL DISCLAIMER
The use of the Internet or this form for communication with the firm or individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form nor should the reader rely on the information listed above as true in all circumstances. This information is provided generally and any similarity between the information listed above and an individual reader's case is purely coincidental.
The attorneys at Hall & Rustom LLC represent clients throughout the entire state of Illinois, including, but not limited to, the cities of Peoria, Morton, Washington, Pekin, Eureka, East Peoria, Dunlap, Metamora, Bartonville, Bloomington, Normal and any legal matter located in Peoria County, Tazewell County, Woodford County, Marshall County, Stark County, Henry County, Knox County and McLean County.
What are the main changes in 2011 to Illinois Worker's Compensation Laws?
The two biggest changes under the
2011 Illinois Workers Comp Reforms are
1) Reduction of
the Medical Fee Schedule rates by 30%; and
2) The
introduction of employer Preferred Provider Programs plans approved by the IL
Dept of Insurance that attempt to limit the employer's liability for medical
treatment.
The injured worker can only
"Opt-Out" of the employer's PPP plan in writing and before exhausting
their 2 choices of doctor in network. After using up 2 choices of physicians
within the PPP network, the injured worker can only request a hearing at the
Commission for a finding on the "adequacy of care" to see if they are
allowed to go out of network.
The not so obvious medical treatment options following the new reforms are:
(1) if the employer has no PPP provider, the employee retains the right to choose 2 doctors;
(2) if the employer has an Illinois workers comp PPP plan and notifies the injured employee of the PPP plan in writing, soon after receiving the report of injury, injury treatment options are limited to the PPP plan or;
(3) if the employee declines the PPP and Opts-out (in writing) before treating with the PPP plan, the worker automatically loses 1 choice of doctor and has only 1 choice of doctor left to go outside of network;
(4) if the employee "opts out" (in writing) after initial treatment by a PPP plan doctor, they also have only 1 choice of doctor left to go outside of network;
(5) if the employee stays in network and uses up both choices of doctor in network, they have no doctor choices left -- they can only go outside of network upon a hearing at the Commission and after a finding of "improper or inadequate" medical care.
Official Language for Notification to Employees of Employer Selected
PPP
The Illinois Workers Compensation
Commission has approved the official language to be used to notify injured
employees of employer selected "Preferred Provider Programs" (PPP)
that is, employer selected medical networks for work injury related medical
care. (ATTACHED FOR YOUR REVIEW) This is
the official form language to be used to notify the injured employee of the
employer's selection of their medical provider network as soon as the employer
is made aware of the work injury.
Employers can voluntarily issue an advance notice of workers comp medical network (ATTACHED FOR YOUR REVIEW) by using the additional form language provided. However, even if the advanced general notice of workers comp medical network is posted or given to all employees, the above official Notice of Workers Comp Medical Provider (PPP) must still be issued in a timely manner soon after the employer receives notice of an actual work accident or work injury.
These PPP networks must still be approved by the IL Dept of Insurance and approvals are expected for use by Jan 1, 2012. The Illinois Department of Insurance is currently accepting Preferred Provider Program applications for approval and as the process unfolds, the approved list of "Preferred Providers" will be available on their website.
To view FAQ’s regarding PPP’s,
please see http://insurance.illinois.gov/Main/FAQ.pdf.
Other 2011 Changes to Worker’s Compensation Act
The Amendment to Section
8.1(b) of the Illinois Workers’ Compensation Act delineates the determination
of permanent partial disability. For all accidents occurring on or after
September 1, 2011, permanent partial disability shall be established by a
licensed physician reporting on the level of impairment in writing.
The Amendment to Section
8(e)(9) the Illinois Workers’ Compensation Act specifically delineates hand
injuries involving carpal tunnel syndrome due to repetitive or cumulative
trauma be returned to their pre-2005 scheduled amount of 190 weeks, and places
a disability limit of 15% loss of use of the hand in such cases, unless clear
and convincing evidence can show an award should exceed this amount. In such
cases the award should not exceed 30% loss of use of the hand.
The Amendment to Section
8(d)(1) of the Illinois Workers’ Compensation Act confirms any award for wage
differential for accidents occurring after September 1, 2011 shall be effective
only until the employee reaches the age of 67 or five years from the date the
award becomes final, whichever is later.
The Amendment to Section
11 of the Illinois Workers’ Compensation Act provides an intoxication defense;
however, this was greatly limited. The new section confirms no compensation
shall be payable if an employee’s intoxication is the proximate cause of the
employee’s accidental injury at the time of the accident, or if the employee
was so intoxicated the intoxication constituted a departure from the
employment.
If you have further questions, please visit our website at www.centralillinoislawyers.com and complete our online submission form. Or, you can call our office at 309-699-4691 or email us at how@howlawfirm.com.
LEGAL DISCLAIMER
The use of the Internet or this form for communication with the firm or individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form nor should the reader rely on the information listed above as true in all circumstances. This information is provided generally and any similarity between the information listed above and an individual reader's case is purely coincidental.
The attorneys at Hall & Rustom LLC represent clients throughout the entire state of Illinois, including, but not limited to, the cities of Peoria, Morton, Washington, Pekin, Eureka, East Peoria, Dunlap, Metamora, Bartonville, Bloomington, Normal and any legal matter located in Peoria County, Tazewell County, Woodford County, Marshall County, Stark County, Henry County, Knox County and McLean County.
No comments:
Post a Comment