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On May 31, 2026, the Illinois General Assembly passed HB5228.
The bill amends several provisions of the Illinois Workers’ Compensation Act.
The legislation faced significant opposition from employer and business
interests during the legislative process.
The most notable changes are the amendments to Sections 12 and 8.7. Governor
JB Pritzker has 60 days to approve, sign, or veto the bill. At this time, it
appears the bill will be enacted into law.
I. Amendment to Section 12 of the Illinois Workers' Compensation Act
- If an employer
chooses to obtain an independent medical examination/opinion regarding
the reasonableness and necessity of treatment instead
of utilizing the utilization review process, the reviewing medical
practitioner must issue the examination report within 90 days.
This does not appear to apply to independent medical examination
opinions regarding causation.
- The 90-day period
begins when the employer receives the medical records from the treating
provider requesting the treatment.
- The employer must
exercise due diligence in obtaining those records from the treating
provider.
- The reviewing
practitioner must be board certified in the same specialty
as the employee's treating health care professional.
- For example, if
the treating physician is an orthopedic surgeon, the reviewing
physician must also be board certified in orthopedic surgery.
- The examination
report must be provided to:
- the employee;
- the employee's
representative (such as an attorney); and
- the treating
health care professional.
Consequences for Missing the 90-Day
Deadline
If the employer fails to comply with these requirements after receiving the
necessary medical records:
- A rebuttable
presumption arises that the employer is responsible for additional
penalties and attorney’s fees under Sections 16 and 19(l) of the Act.
- A rebuttable
presumption means the employer is presumed liable unless it can present
some evidence to overcome that presumption.
What Conduct Is Covered?
The provision applies to:
- Failure to
authorize or approve treatment; and
- Failure to pay
for medical treatment.
II. Utilization Review – Section 8.7
The bill substantially revises utilization review requirements and
significantly limits who may conduct reviews and issue adverse
determinations.
- Only licensed
health care professionals may determine whether a medical service is
medically necessary during utilization review.
- If the treatment
was recommended or provided by a physician, any denial or other adverse
determination must be made by a physician.
- The reviewing
physician must:
- Hold a current,
unrestricted medical license in the United States;
- Be board
certified in the specialty relevant to the treatment being reviewed;
and
- Have actual
experience treating and managing patients with the same condition or
disease involved in the request.
- A licensed health
care professional may deny a request from another provider only if the
reviewer is licensed in the same profession as the provider who
submitted the request.
- For example, a
treatment request submitted by an orthopedic surgeon must be reviewed
by a physician who is board certified in orthopedic surgery.
III. Burial Benefit
The bill increases the statutory burial benefit under Section 7(f) from $8,000 to
$10,000.
IV. Funding for the Illinois Workers’ Compensation Commission
The bill establishes a pro rata surcharge on insurance carriers to achieve an
annual funding target for the Illinois Workers’ Compensation Commission.
V. State Licensure Compliance
The bill requires State-licensed entities to comply with Illinois workers’
compensation insurance requirements.
Employer Considerations and Recommended Next Steps
The amendments to Sections 12 and 8.7 represent some of the most significant
changes to Illinois workers’ compensation claims administration in recent
years and are likely to have a substantial impact on approval of medical
treatment.
Employers should begin evaluating their workers’ compensation programs now to
ensure compliance with the new requirements if the bill becomes law. Failure
to comply with these provisions may increase exposure to penalties, adverse
presumptions, and challenges to treatment denials.
We will continue to monitor HB5228 as it moves to Governor Pritzker for
consideration and will provide updates regarding enactment, effective dates,
and implementation issues. If you have questions regarding these amendments
or their impact on your workers’ compensation program, please contact any
attorney in our office. We would be pleased to discuss the practical
implications of the legislation and assist with any questions or concerns.
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