CHANGES COMING TO THE ILLINOIS WORKERS’ COMPENSATION ACT

The Illinois General Assembly ended the spring legislative session in the early morning hours of June 1, 2026.  While the primary focus of the session was the state budget, the General Assembly found time to adopt amendments to the Illinois Insurance Code and the Workers’ Compensation Act.  HB 5228 passed in both chambers, and it now awaits the governor’s signature.

HB 5228 does the following:

1. Provides for additional funding for the Illinois Workers’ Compensation Commission by  setting an annual funding target and providing for an additional amount to be paid by insurance companies calculated from the company’s underwriting gains.  Amendment to Section 416 of the Illinois Insurance Code.
2. Provides that any business requiring licensure by a State agency for which having proof of workers’ compensation insurance coverage is a requirement for licensure shall be subject to civil penalties for failing to have workers’ compensation insurance coverage. Amends Section 4 of the Illinois Workers’ Compensation Act.
3. Increases the burial expense for fatal cases to $10,000.00.  Amends Section 7 of the Illinois Workers’ Compensation Act.
4. For Utilization Review, the following changes were made to Section 8.7 of the Illinois Workers’ Compensation Act:
   1. The reviewing physician must have the following, if making an adverse determination.
      1. A valid, unrestricted license in any United States jurisdiction.
      2. A current board certification by a recognized American medical specialty board in the area or areas appropriate for the treatment reviewed.
      3. Experience treating and managing patients with the medical condition or disease for which treatment is being requested.
   2. Certification of treatment shall be valid for 3 months immediately after the healthcare provider receives the certification or for the length of treatment as determined by the employee’s healthcare provider.
   3. Certification for surgery shall be inclusive of 3 months of postoperative healthcare services as clinically indicated by the treating healthcare professional or for the length of treatment as determined by the treating healthcare professional.
   4. When a non-certification is appealed, the appeal shall be reviewed by a physician who has the same credentials and requirements as listed under “a” above.
5. For Section 12 examinations, the bill makes changes to Section 12.  If the physician is asked to comment on the reasonableness and necessity of medical services proposed under Section 8(a), the following will be required:
   1. The report shall be provided to the employee or the employee’s representative AND the employee’s healthcare professional.
   2. The report shall be provided within 90 days after the employer receives the request for the examination of the reasonableness and necessity of medical treatment.
   3. The 90-day period begins when the employer receives the medical records from the treating physician requesting the medical services.
   4. The employer and its representative shall exercise due diligence in requesting and collecting medical records in accordance with all allows.
   5. The Section 12 physician must be board certified in the same specialty as the treating physician.
   6. Failure to comply with the new requirements creates a rebuttable presumption that the employer is responsible for the payment of additional compensation under Section 16 and Section 19(l).
   7. The penalties apply to the failure to authorize or approve treatment as well as the failure to pay for treatment.

The changes to Section 12 are applicable only to when the examining physician is asked to comment on whether medical treatment is reasonable and necessary.  The changes do not apply when the questions posed to the examining physician ask about medical causation, work status or maximum medical improvement. 

The changes have not yet gone into effect, but it is expected Governor Pritzker will sign HB 5228 into law at which time the changes will be effective immediately.  Ganan & Shapiro will keep you up to date on when the changes go into effect.  In addition, our September 24, 2026 Webinar will discuss Independent Medical Evaluations under Section 12 of the Act, and we will include discussion of the new provisions to Section 12 and Section 8.7 as part of the presentation.  

If you have any questions about the changes, please reach out to any of our attorneys.