Illinois Insurance Facts Workers' Compensation Insurance Revised April 2003

Workers' compensation insurance is a system of benefits provided by law to most workers who have job-related injuries or illnesses. Workers' compensation benefits are provided by licensed insurance companies, self-insured employers approved by the Illinois Workers' Compensation Commission, or group self-insurers who have pooled their liabilities. Generally, the Illinois Workers' Compensation Commission is the agency that handles problems involving workers' compensation. The Illinois Division of Insurance has limited involvement. This fact sheet provides an over-view of workers' compensation insurance in Illinois.

Who Must Carry Workers' Compensation Insurance?

The Illinois Workers' Compensation Act requires all employers to post a notice in the workplace that explains workers' rights and lists the name and address of the workers' compensation insurance carrier or, if the employer is self-insured, the name and address of the company that services compensation payments. Harassment, discharge, refusal to hire, or discrimination against an employee for exercising his/her workers' compensation rights is prohibited by law.

What Does Workers' Compensation Insurance Cover?

It is the employer's responsibility to pay for reasonable medical care for an employee's work-related injury or disease.

The medical treatments that should be covered by the employer include

• Necessary first aid and emergency services;
• Two treating physicians, surgeons, or hospitals of the employee's choice;
• Additional medical care providers to whom the employee is referred by the two physicians, surgeons, or hospitals.

The employer is also required to pay for necessary physical, mental, and vocational rehabilitation treatment programs that assist in the employee's recovery and return to work. The employee, however, must cooperate in reasonable treatment programs.

What Can the Division of Insurance Do?

The Division of Insurance may be able to assist you in these situations:

1. A balance billing problem - If you have a legitimate workers' compensation claim, you should not be financially responsible for any covered bills. However, if the workers' compensation carrier pays less than 100% of the billed charges (for example, reductions taken due to usual and customary fees), the medical provider might bill you for the unpaid balance. If you are experiencing balance billing problems, you should contact the Division of Insurance for assistance. However, we are only able to assist when the workers' compensation carrier is an insurance company. We cannot assist if a self-insured employer is offering the workers' compensation benefits.

2. A work comp audit dispute - Increased premiums can cause a dispute between the employer and the insurance company. If you are an employer who needs assistance in this situation, you can file a complaint with the Division of Insurance. We will conduct an investigation to make sure the insurance company is operating in compliance with the laws we govern.

3. An insurance company dispute - If the Illinois Workers' Compensation Commission makes a ruling on your workers' compensation claim, but the insurance company doesn't comply with the ruling, contact the Division of Insurance for assistance.

If you would like the Division of Insurance to assist you with one of the problems explained above, you can file a complaint electronically or obtain a complaint form by calling one of the numbers listed at the bottom of this fact sheet.

Note: These are the only workers' compensation situations we can investigate. All other problems regarding workers' compensation claims, including claim delays, claim disputes, or claim denials, should be directed to the Illinois Workers' Compensation Commission.

How Do I Contact the Illinois Workers' Compensation Commission?

For further assistance with workers' compensation problems, you should contact the Illinois Workers' Compensation Commission via their web site http://www.iwcc.il.gov/, or at one of the following numbers:

Each regional office can explain the Illinois Workers' Compensation Commission's procedures and provide materials to assist with workers' compensation claim problems.

For More Information

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