Effective July 20, 2005, amendments to the Illinois Workers’ Compensation Act (“Act”) prohibit providers from billing patients for medical care for work-related injuries, and after payment from the employer, from recovering the difference between the provider’s charge and the payment received.

New section 8.2 of the Act requires a provider to bill the employer directly when the patient notifies the provider that the charges were incurred to treat a work-related illness or injury, and the patient gives the provider the name and address of the responsible employer. The payment due from the employer is the lesser of the actual charges or the amount required under a fee schedule established by the Workers’ Compensation Commission (“Commission”). The employer must pay the claim within 60 days after receipt of a claim containing substantially all of the information necessary to determine the amount due under the statutory formula. Unpaid bills, including nonpayment of a portion of the bills, incur interest at the rate of 1% per month payable to the provider.

A provider may not bill a patient for the difference between the provider’s charge and the payment from the employer or insurer. If an employer notifies the provider a claim is denied, the provider may collect actual charges from the patient. If an employer notifies the provider that the employer will pay only a portion of the claim, the provider may collect the remainder of the bill from the patient up to the lesser of the actual charge or the payment level set by the statutory fee schedule. However, once the patient informs the provider that a claim is filed with the Commission to resolve a claim dispute, the provider must stop all collection efforts on charges related to the workers’ compensation claim. If the patient has group medical insurance, the provider may submit a claim to the health plan.

The new amendments have a retroactive effect on lawsuits filed to collect accounts. Illinois courts hold that a judgment obtained prior to a legislative amendment vests the right to collect the judgment under the law existing when the judgment was entered. Therefore, the collection of judgments entered against patients before July 20, 2005, is not subject to the stay on collections. In contrast, collection suits filed prior to July 20, 2005, but not reduced to judgment before July 20, 2005, must be stayed. Any statute of limitations applicable to a provider’s right to payment are tolled from the date the worker’s compensation claim is filed to the date the Commission rules the claim is not a compensable claim.

If the final award in the workers’ compensation case denies any portion of the claim, a provider may resume collection from the patient. The patient is responsible for the billed amount, plus interest at the rate of 1% monthly accruing from 61 days after the employer was billed to the date of full payment.

For further information, please contact Victoria R. Glidden or your regular Hinshaw attorney.