8/21/2009

Illinois Workers Compensation Medical Fee Schedule Seminars


8-21-09

The Workers Compensation Commission will hold public seminars for payers and providers to review the new Illinois Workers Comp Medical Fee Schedule for injury related medical care on or after Feb.1, 2009. (Instructions and Guidelines for Treatment )

Payer and Provider Seminars are now scheduled: Mount Vernon (10/13/09), Collinsville (10/14/09), Springfield (10/28/09), Chicago (11/3 and 11/4/09), Peoria (11/10/09) and Rockford (11/17/09) see dates and locations and registration information.

The Illinois Workers Comp Medical Fee Schedule sets forth maximum limits for 1) ambulatory surgical centers 2) hospital outpatient surgery, radiology, laboratory, physical medicine and rehabilitation services and 3) new rates for specialized rehabilitation hospitals.

Maximum payment rates are now set as the lesser of 1) the listed Fee Schedule amount 2) the actual amount charged or 3) the contract "negotiated" rate in provider contracts. An existing contract will control over amounts in the new fee schedule. Interest charges may apply for late payment after 60 days but only after providers supply the necessary minimum information required.

For assistance call our office at (312) 541-0049 or email us at beb@workcomp-chicago.com


Chicago Workers Compensation Attorney
-- 8-21-09

8/18/2009

Mandatory Insurer Reporting User Manual Released 8-04-09

8-18-09

We often report on important developments involving Medicare coordination with Illinois workers compensation claims. For those following the Mandatory Insurer Reporting requirements (MIR), the Centers for Medicare & Medicaid Services (CMS) released an updated Liability and Workers Compensation Insurance User Guide Version 2 dated 8-04-09. The 225 page document is offered to help insurance carriers and administrators understand upcoming claim reporting requirements for cases involving Medicare beneficiaries.


CMS also released an "Alert" dated 7-31-09 to define who is required to report under the new law -- that is anyone that CMS terms a Responsible Reporting Entity (RRE). The definition essentially boils down to any party that is responsible to pay the claim which may include the members of insurance risk pools, self insureds companies, any company with a deductible and workers compensation insurance carriers.


This document is in draft only and is subject to revision after additional public comment. It attempts to solve the double reporting problem with companies that keep deductibles or self insured retentions (SIR) and tries to define exactly who or what entity is responsible for the claim reporting.


Chicago Workers Compensation Attorney -- 8-18-09

8/10/2009

Illinois Workers Compensation Medical 2 Doctor Rule


8-11-09

Illinois workers compensation allows injured workers to have a choice of picking two doctors for treatment. Hospital emergency care does not count as a choice of doctor but after that, if you start medical treatment with any physician, it is going to be considered as using one of your two choices for a doctor.

Your initial doctor can refer you to as many specialists or therapists as are necessary to evaluate and treat your injuries. But say you have a disagreement with your 1st doctor or you feel not enough is being done to treat your injury. Section 8(a) of the Illinois Workers Compensation Act allows for a 2nd independent choice of doctor at the employer's expense under workers compensation. A third choice of doctor will not be paid for as a medical expense under Illinois workers comp to prevent doctor shopping.

All injured workers should be aware of the two doctor rule or they may find themselves paying out of pocket for medical care that should have been covered in workers compensation medical benefits. And, an Illinois workers compensation attorney will not be able to force payment of those medical bills because by law an employer is not responsible for a 3rd choice of doctor.

For a review of basic rules and Illinois workers compensation benefits, see our web site for a short article outlining basic benefits. A recent court case also reinforces the two-physician rule where a worker received some free acupuncture, it did not count as a choice of physician. See the Appellate Court's most recent decision on the 2 doctor rule at Comfort Masters (May 2008).

For further questions concerning medical treatment or workers compensation benefits contact a Chicago Workers Compensation attorney for answers and assistance. Our Attorneys at WorkComp Chicago have handled Illinois work injury claims for over 20 years with a 98% overall success rate. Aggressive Illinois workers compensation attorneys with a strong record of success in workers compensation settlements, trials and appeals.


Chicago Workers Compensation Attorney 08-11-09

Illinois Truckers as Independent Contractors or Employees; Nature of the Business Test Matters

8-10-09

Illinois adopted a stricter test in 2007 that favors classifying workers as an employee rather than as an independent contractor. No single factor determines whether a worker will be classified as an employee or an independent contractor but the factors that will be considered are as follows:
  • whether the employer dictates the person's schedule
  • whether the employer pays the person hourly
  • whether the employer withholds taxes
  • whether the person can be discharged (fired) at will
  • and most important whether the employer may control the manner in which the work is done
Every case will of course be looked at individually but the courts will now look at whether the worker's services form a regular part of the employer's general business or whether their duties are part of their own separate business. If that's so, many workers will now be presumed to fall under workers' compensation coverage like in the case of many truck drivers and construction workers who are regularly and wrongly named as independent contractors.

There is a growing trend to classify owner-drivers of trucks as employees when they work continuously for a company and that driving forms an integral part of the employers business. By the court looking to the "nature of the business" test more workers who are labeled independent contractors will be treated as employees for workers compensation and be entitled to Illinois workers compensation benefits.

The Illinois Supreme Court announced the new "integral nature of the business" decision in Roberson (May 2007)

Many Illinois workers are wrongly classified as independent contractors to save the employer from workers compensation premiums and withholding taxes. Injured workers should contact an Illinois workers compensation attorney to determine whether they should be covered by Illinois workers compensation.

For questions call a Chicago workers compensation attorney for answers and assistance with a claim for benefits at info@workcomp-chicago.com.


Chicago Workers Compensation Attorney 8-10-09