Workers’ Compensation Claim Payment

What’s new?

  • On November 27, 2018 the Illinois House followed the state Senate and voted to override Governor Rauner’s veto and on November 29, SB 904 became law.
  • Thank you to all the AMITA Health associates and partners who took action to support the veto override.  Specifically, this new law will –
    • Allow providers a method to collect interest on late medical claims by filing a claim for this interest in circuit court.
    • Require workers’ compensation insurance companies to send an Explanation of Benefits to physicians explaining why they have denied the authorization of medical care, or what
      additional information they need to make a decision on that care.
    • Prevent workers’ compensation insurers from ignoring the law requiring them to use electronic billing for workers’ compensation claims.
  • On August 28, 2018, Governor Rauner amendatory vetoed SB 904, saying it “dramatically tips the balance [of the workers’ compensation system] in favor of medical providers.”
  • The legislature is able to vote to override a Governor’s veto during the legislative veto session later this fall. Please click here to contact your legislators to ask them to vote to override the Governor’s veto.
  • On May 30, 2018 the bill passed the Illinois State House with a vote of 105 – 11 and on May 31 the Illinois State Senate passed the legislation with a vote of 38 – 7.

What is the issue?

  • Physicians and healthcare providers across the state have been dealing with a growing crisis where insurance companies are not paying workers’ compensation medical bills.
  • In many cases, providers who care for injured workers are forced to wait years for reimbursement from workers’ compensation insurance companies for “pre-authorized” treatment.
  • When payments do arrive, they do not include late-payment interest which is required under current law.
  • Many workers’ compensation insurance companies still do not use electronic billing which is also required by current law.  This paper-based system not only forces provider to spend thousands of dollars on certified mail, it often causes delayed care.

Why does it matter?

  • While delayed payment is not a new issue for providers treating injured workers, the delays have increased significantly over the past couple of years, especially for payment for “pre-authorized” workers’ compensation medical care.
  • Even though the insurer has authorized the medical care for an injured worker (through a paper notification), they are now delaying payment until the claim at the Workers’ Compensation Commission is resolved, which can take as long as three years.
  • In the meantime, the health care provider is responsible for the costs of the care and has no legal recourse or ability to collect interest on the delayed payments.
  • More and more doctors, hospitals, and other medical professionals are finding it difficult to provide care to injured workers under the current situation.
  • Any reduction in access to medical care will increase the time that injured workers are off of work and increase the long-term effects of their injuries – both of which could actually increase costs for employers, in addition to the negative effects on workers.

What is the AMITA Health perspective?

  • Injured workers need access to proper medical care in order to get well and back to work.  Some providers may no longer be able to take on new workers’ compensation patients when they are waiting years for payment for services provided to current patients. Fewer available providers will make it harder for injured workers to access the care they need to return to work and live healthy productive lives.
  • AMITA Health is committed to working towards a sustainable workers’ compensation system. As a large employer of 26,000 associates and one of the largest health systems in the state of Illinois, we understand the need for a fair workers’ compensation system that is affordable for employers while also providing quality care for injured workers.  But we believe that cost-savings for the system should not be achieved by cutting payment rates or delaying payments to health care providers.
  • Current laws should be enforced.  Current law states that providers are entitled to interest on late payments, and workers’ compensation insurance companies are required to use electronic billing.  These laws were passed to streamline the system for workers’ and those who care for them.  Insurers should not be able to selectively comply with state law.