reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 50 - INSURANCE › Part 2903 - WORKERS' COMPENSATION EXPERIENCE REPORTING › Section 2903.10 - Authority

Current through Register Vol. 48, No. 28, July 12, 2024
This Part is promulgated by the Director of Insurance under
				Section 401 of the Illinois Insurance Code (Ill. Rev. Stat. 1985, ch. 73, par.
				1013), which empowers the Director to make reasonable rules and regulations as
				may be necessary for making effective the insurance laws of this State. This
				Part implements Section 466 of the Illinois Insurance Code (Ill. Rev. Stat.
				1985, ch. 73, Section 1065.13 ).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2903 - WORKERS' COMPENSATION EXPERIENCE REPORTING › Section 2903.20 - Purpose and Scope

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of this Part is to implement Section 466 of the
				Illinois Insurance Code by requiring the recording and reporting of premium,
				loss and expense experience for companies that write workers' compensation and
				employers' liability insurance in order to aid the Director of Insurance in
				determining whether rating systems on file with the Department of Insurance for
				such companies comply with the standards set forth in Section 456 of the
				Illinois Insurance Code (Ill. Rev. Stat. 1985, ch. 73 par. 1065.6 ). This Part
				shall apply to all insurers licensed to write workers' compensation and
				employers' liability insurance in this State.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2903 - WORKERS' COMPENSATION EXPERIENCE REPORTING › Section 2903.30 - Statistical Agent

Current through Register Vol. 48, No. 28, July 12, 2024
The Director of Insurance shall designate a statistical agent
				to assist in the recording and reporting of premium, loss and expense
				experience for workers' compensation and employers' liability insurance
				required pursuant to this Part. The designated statistical agent shall, subject
				to the approval of the Director of Insurance, develop a statistical reporting
				plan. The Director shall approve the statistical reporting plan if it meets the
				standards set out in Section 466(1) of the Illinois Insurance
				Code.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2903 - WORKERS' COMPENSATION EXPERIENCE REPORTING › Section 2903.40 - Reporting

Current through Register Vol. 48, No. 28, July 12, 2024
Every insurer who is a member or subscriber of the designated
				statistical agent shall record and report its premium, loss and expense
				experience to the agent in accordance with the statistical reporting plan
				developed by the agent and approved by the Director of Insurance. Insurance
				companies that are not a member or subscriber of the designated statistical
				agent must record and report their premium, loss and expense experience to the
				Director of Insurance in accordance with a filed statistical reporting plan. On
				an annual basis, the designated statistical agent shall compile such statistics
				in a format approved by the Director of Insurance and submit such compilation
				to the Department of Insurance. A format for the compilation of such statistics
				will be approved by the Director if it provides a complete summary (which
				includes but is not limited to direct premiums written, direct premiums earned,
				losses paid, losses incurred, loss reserves, and all expenses including loss
				adjustment - both allocated and unallocated) of all data collected under the
				statistical reporting plans and meets the confidentiality requirements of
				Sections 466(1) of the Illinois Insurance Code.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2903 - WORKERS' COMPENSATION EXPERIENCE REPORTING › Section 2903.50 - Statistical Plan

Current through Register Vol. 48, No. 28, July 12, 2024
The statistical reporting plan approved by the Director of
				Insurance shall be maintained by the Director of Insurance and made available
				for public inspection. In addition, a copy of this plan shall be filed with the
				State Library of the Secretary of State's Office.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.10 - Statutory Authority

Current through Register Vol. 48, No. 28, July 12, 2024
This Part is promulgated by the Director of Insurance pursuant
				to Sections 401 and 466 of the Illinois Insurance Code (Code) [215 ILCS 5/401
				and 466 ].
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.20 - Purpose and Scope

Current through Register Vol. 48, No. 28, July 12, 2024
It is the purpose of this Part to provide the requirements and
				procedures for participation in the Illinois Assigned Risk Plan for Workers'
				Compensation Act [820 ILCS 305 ] and Workers' Occupational Diseases Act [820
				ILCS 310 ] Coverage. This Part shall apply to every carrier writing or making
				Workers' Compensation and Occupational Diseases Acts insurance in the State of
				Illinois. This Part shall also apply to every employer seeking Assigned Risk
				Insurance and licensed producers acting on behalf of those
				employers.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.30 - Written Acceptance Required of All Insurance Carriers Writing Workers' Compensation and Occupational Diseases Insurance in Illinois

Current through Register Vol. 48, No. 28, July 12, 2024
Every carrier writing Workers' Compensation and Workers'
				Occupational Diseases insurance in the State of Illinois shall file with the
				Director of Insurance two copies of its written acceptance of all provisions of
				the Workers' Compensation Act and Workers' Occupational Diseases Act by
				assignment of the Department of Insurance and providing for the pooling of
				losses and penalties for violation of those Acts.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.40 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
As used in this Part, the following terms have the definitions
				set forth:
"Act" means the Workers' Compensation Act [820 ILCS 305 ] and
				Workers' Occupational Diseases Act [820 ILCS 310 ].
"Administrator " means a qualified entity who administers the
				managing of the Illinois Workers' Compensation Assigned Risk Plan in compliance
				with the Plan and appropriate statutes/regulation. At a miminum, a qualified
				entity holds a valid Illinois license that enables it to develop and file its
				Plan and associated rates, rating plans, rules, forms and manuals.
"Assigned Carrier" means the insurance company that the
				Administrator has determined shall provide coverage to an eligible employer who
				has applied for an assignment pursuant to this Part.
"Plan" means the Illinois Workers' Compensation Assigned Risk
				Plan as filed by the Administrator and approved by the Director.
"Producer" means a person required to be licensed under Section
				500 of the Illinois Insurance Code [215 ILCS 5 -500] to sell, solicit or
				negotiate insurance.
"Standard Coverage" means Workers' Compensation and Workers'
				Occupational Diseases insurance written on a basic rating plan, exclusive of
				deviated rating plans or retrospective rating plans.
"Termination" means the cessation of coverage by either
				cancellation of a policy which is in force or not renewing a policy at the end
				of the coverage period.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.50 - Designee

Current through Register Vol. 48, No. 28, July 12, 2024
For the purpose of assisting in the assignment of an employer
				to a carrier, the Administrator is appointed the designee of the Department of
				Insurance pursuant to Sections 401 and 468 of the Illinois Insurance Code [215
				ILCS 5/401 and 468 ].
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.60 - Procedure for the Assignment of an Employer

Current through Register Vol. 48, No. 28, July 12, 2024
An eligible employer seeking Assigned Risk Insurance will be
				bound under the Illinois Assigned Risk Plan in accordance with the following
				procedures:
a) Within 60 days prior to
			 application the employer must have requested and been rejected for standard
			 coverage by two nonaffiliated insurance carriers that are licensed to write and
			 are actively writing workers' compensation insurance within the State, one of
			 which shall have been the carrier, if any, with which the employer was last
			 insured for Workers' Compensation and Workers' Occupational Diseases Coverage
			 at the time of application.
b) The
			 producer of the employer shall submit an application for assignment to the
			 Administrator. The Administrator shall review the content of the application.
			 If the application is complete, the Administrator shall calculate the estimated
			 annual premium and notify the employer and licensed producer within 10 days as
			 to the amount of estimated annual premium required. The application may be
			 submitted online to the Administrator; however, coverage is not bound until
			 eligibility is determined by the Administrator and the signed application is
			 received with the appropriate premium. Coverage will be bound by the
			 Administrator and the applicant assigned to an Assigned Carrier in accordance
			 with the applicable Plan rules.
c)
			 The employer or producer must submit the required deposit premium or pay the
			 annual estimated premium. For applications submitted by mail, payments must be
			 in the form of a certified check, cashier's check, or a check drawn on the
			 producer's Premium Fund Trust Account payable to the Administrator for either
			 the required deposit premium or the full amount of the estimated annual
			 premium. If installment payments are requested, the deposit submitted shall be
			 the deposit required by Section
			 2904.100
			 and the Plan. The Administrator will bind coverage at 12:01 a.m. the first day
			 following the date of postmark on the payment envelope, or a later date if
			 requested in the application. For electronic applications, the total initial or
			 deposit premium must be made electronically by credit card or electronic funds
			 transfer (EFT). These payments may be made directly from an employer's account
			 or their producer's account. Mailed checks are not accepted with the online
			 application submission option. The earliest eligible effective date will be
			 12:01 a.m. on the day after receipt of the completed online submission, if all
			 required information and deposit premium is received, as determined by
			 Administrator.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.70 - Procedure for Immediate Binding of Coverage

Current through Register Vol. 48, No. 28, July 12, 2024
An employer seeking Assigned Risk Insurance may be bound under
				the Illinois Assigned Risk Plan in accordance with the following
				procedures.
a) Within 60 days prior to
			 application the employer must have requested and been rejected for standard
			 coverage by two nonaffiliated insurance carriers licensed and actively writing
			 workers' compensation insurance within the State, one of which shall have been
			 the carrier, if any, with which the employer was last insured for Workers'
			 Compensation and Workers' Occupational Diseases Coverage at the time of
			 application.
b) The producer of the
			 employer must contact the Administrator and provide the necessary information
			 for the Administrator to determine the estimated annual premium. A completed
			 and signed application must be received along with the applicable deposit
			 required by Section
			 2904.100
			 and the Plan.
c) Upon receipt of a
			 completed application and required deposit premium, the Administrator shall
			 bind coverage in accordance with Section
			 2904.60(b).
			 The Administrator shall then provide to the assigned carrier the complete
			 binder package electronically the day after binding. The assigned carrier shall
			 provide to the employer and producer an electronic or hard copy notice as to
			 the amount of any additional premium due within 10 days from the date of
			 assignment of coverage from the Administrator and assigned carrier's receipt of
			 the required information. The employer or producer shall remit to the assigned
			 carrier the additional premium, or any additional deposit premium payments due
			 when election is made under Section 2904.100, within 30 days from the date that
			 the notice of additional premium is provided to the employer and producer. The
			 assigned carrier shall maintain proof that the notice of additional premium was
			 provided to the employer and producer. Coverage will be cancelled by the
			 assigned carrier for nonpayment of premium in accordance with Section 143.16 of
			 the Code if the additional premium, or any additional deposit premium due under
			 Section 2904.100, is not received by the assigned carrier within 30 days from
			 the date the notice of additional premium was provided to the
			 employer.
d) The Administrator will
			 not bind coverage if the deposit premium does not accompany the application. If
			 an application is submitted for the binding of immediate coverage which does
			 not contain sufficient information to complete the assignment, the
			 Administrator shall advise the producer by telephone or electronic
			 communication that the application is being rejected and return the appropriate
			 premium funds provided, if any, to the original payor with an explanation of
			 the rejection to the producer. Coverage shall not be considered bound on
			 rejected applications.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.90 - Commissions

Current through Register Vol. 48, No. 28, July 12, 2024
Any casualty producer who is licensed to place insurance
				through the facilities offered herein, shall be entitled to a commission at a
				rate determined by the Department of Insurance. Commissions shall be paid as
				follows:
a) When the payment of
			 premium or premium installment is made by the employer directly to the assigned
			 carrier, within 90 days the assigned carrier shall pay to the producer of the
			 employer the applicable amount of commission due.
b) If there has been no commission paid on an
			 expiring policy or existing policy, and the employer desires that a commission
			 be paid to a producer, the employer shall notify the assigned carrier in
			 writing, or the producer may submit to the assigned carrier a letter of
			 authority signed by the employer appointing the agent or broker as such for the
			 insurance. If the appointment is received by the assigned carrier after the
			 date of renewal, the commission shall be paid on a pro rata basis for the
			 remainder of the policy term.
c) If
			 there has been a commission paid on a policy, the producer of record may be
			 changed upon the request of the employer effective upon the next renewal of the
			 policy.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.100 - Installment Payment of Premium

Current through Register Vol. 48, No. 28, July 12, 2024
Policies with an estimated premium of $1,000 or less shall be
				paid in full. Payment of the estimated annual premium is required in accordance
				with the filed and approved Plan. An installment payment plan may be requested
				by the employer and will be made available only in accordance with the filed
				and approved Plan rules. The Illinois Workers' Compensation Commission
				surcharge is not a premium and must be paid in full, in addition to the
				required deposit premium, prior to binding of coverage.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.110 - Insurance Policy to be Issued by Assigned Carrier Within Ten Days After Receipt of Payment

Current through Register Vol. 48, No. 28, July 12, 2024
A policy or binder shall be issued to the eligible employer and
				producer within 10 days after receipt of the required premium
				payment.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.130 - Renewal of Policies Issued Under this Part

Current through Register Vol. 48, No. 28, July 12, 2024
a) The assigned carrier shall, 60 days prior
			 to the expiration of the policy, submit to the employer and producer a notice
			 of premium for renewal of the policy. If the renewal premium is not received by
			 the assigned carrier 30 days prior to the expiration of the policy, the
			 assigned carrier shall issue a notice of expiration.
b) If the renewal premium is received prior
			 to the expiration date, the policy shall be renewed without lapse in coverage.
			 If the renewal premium is received within 30 days after the expiration date,
			 the policy shall be renewed effective 12:01 a.m. on the first day following the
			 date of postmark on the payment envelope. If the renewal premium is received
			 more than 30 days after the expiration date, the premium may be refused and the
			 employer may apply for assignment pursuant to Sections
			 2904.60
			 or
			 2904.70.
			 The assigned carrier may accept renewal premiums more than 30 days after the
			 expiration of the policy, which renewal shall be effective 12:01 a.m. on the
			 first day following the date of postmark on the payment envelope.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.140 - Policy Termination - General

Current through Register Vol. 48, No. 28, July 12, 2024
The assigned carrier may terminate a policy issued under this
				Part as permitted by law. The termination notice shall indicate whether the
				policy is being cancelled or nonrenewed. The termination notice shall include
				the proposed date of termination, the reason or reasons for the termination,
				and all other information required by law. The termination notice shall notify
				the employer of the hearing procedures set forth in Section
				2904.160.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.150 - Policy Termination for Failure to Comply With Employee Welfare Laws

Current through Register Vol. 48, No. 28, July 12, 2024
Termination for failure to comply with Employee Welfare Laws
				shall be based upon a finding of violation by the appropriate Federal, State or
				local enforcement authority. The termination request shall indicate the
				applicable law, date of violation and the enforcement authority which entered
				the finding.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.160 - Policy Termination - Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
a) An employer who wishes to object to the
			 reason or reasons for termination shall, within 10 days after receipt of the
			 notice of termination, mail or deliver to the Director of Insurance a written
			 request for a hearing that shall clearly state the basis for the objection.
			 This Section shall not apply to cancellations at the employer's request or to
			 cancellations in the case of nonpayment of premium as defined in Section 143.13
			 of the Code. The notice of cancellation or nonrenewal to which this Section
			 applies shall advise the named insured of his or her right to appeal and the
			 procedure to follow for the appeal.
b) Within 10 days after receipt of the
			 request for a hearing and upon 10 days notice to the parties, the Director
			 shall convene a hearing. Within 20 days after the conclusion of the hearing,
			 the Director shall issue his or her written findings to the parties. The policy
			 will remain in force until the Director has given his or her findings. If the
			 Director finds for the employer, he or she shall order the assigned carrier to
			 rescind its notice of termination. If the Director finds for the assigned
			 carrier, he or she shall order that the termination be effective 30 days from
			 the date of his or her order. The assigned carrier is entitled to a premium for
			 any extension of coverage and the extension shall be contingent upon the
			 payment of the premium.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.170 - Policies of Insurance and Termination Notice to be Imprinted "Assigned Risk"

Current through Register Vol. 48, No. 28, July 12, 2024
All assigned carriers shall stamp or print on all policies or
				binders of Insurance or Termination Notices filed pursuant to this Part the
				words "Assigned Risk" in letters not less than 3/8 of an inch
				high.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.180 - Annual Reports Required of Mutual and Stock Insurance Pools

Current through Register Vol. 48, No. 28, July 12, 2024
The Mutual and Stock Pools shall each file with the Department
				of Insurance, not later than March 1st of each year, a report showing for the
				previous calendar year:
a) The total
			 combined compensation premium and number of policies written in Illinois under
			 both the Workers' Compensation Act and the Workers' Occupational Disease
			 Act.
b) Total assigned risk
			 premium, both written and earned, on assigned risk policies issued.
c) The total losses on assigned risk Workers'
			 Compensation and Workers' Occupational Diseases policies during the
			 year.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.190 - Rating Standards

Current through Register Vol. 48, No. 28, July 12, 2024
All assigned carriers shall rate all policies issued under this
				Part in accord with the Manuals of Rules and Rates filed with the the
				Administrator and approved by the Department of Insurance. The Administrator
				shall establish audit procedures and a remediation program to evaluate an
				assigned carrier's compliance with this Section and establish corrective
				measures as required by the remediation program. The audit procedures and
				remediation program established pursuant to this Section shall be made
				available to assigned carriers.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.200 - Location of Servicing Office and Records

Current through Register Vol. 48, No. 28, July 12, 2024
All assigned carriers shall have their records readily
				available. All assigned carriers shall include with the premium notice the name
				and telephone number of the person to contact concerning the
				policy.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2904 - ASSIGNED RISK PROCEDURES › Section 2904.220 - Procedure to be Followed in the Suspension of Insurance Carriers for Non-Compliance with this Part

Current through Register Vol. 48, No. 28, July 12, 2024
If any carrier refuses or neglects to comply with any of the
				provisions of this Part, the Director shall pursue the suspension of the
				Certificate of Authority of that carrier.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2905 - REGISTRATION OF WORKERS' COMPENSATION UTILIZATION REVIEW ORGANIZATIONS › Section 2905.10 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Act" means the Workers' Compensation Act [820 ILCS 305
				].
"Department" means the Illinois Department of Insurance.
"Director" means the Director of the Illinois Department of
				Insurance.
"Utilization Review" means the evaluation of proposed or
				provided health care services as defined in Section 8.7 of the Workers'
				Compensation Act.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2905 - REGISTRATION OF WORKERS' COMPENSATION UTILIZATION REVIEW ORGANIZATIONS › Section 2905.20 - Registration

Current through Register Vol. 48, No. 28, July 12, 2024
a) On or after July
			 1, 2005, a workers' compensation utilization review organization may not
			 conduct utilization review for workers' compensation services as provided by
			 Section 8.7 of the Act unless the utilization review organization has
			 registered with the Director. An application for registration shall be made
			 using the standard form available on the Department website (
https://insurance.illinois.gov
),
			 and must be signed by an officer or director of the utilization review
			 organization. Initial registration applications shall be deemed approved unless
			 the Director finds the application to be noncompliant with either the standards
			 set forth in Section 8.7 of the Act or this Part.
b) The application for registration shall
			 include, but not be limited to, the following information: applicant's
			 identifying and contact information; applicant's agent for service of process
			 in Illinois; applicant's accreditation status; signed affirmation by an officer
			 or director; and for each utilization review program: contact information and
			 business hours; organization and governing structure; number of reviews in
			 Illinois for the current and previous years; description of the grievance
			 process; written policies and procedures for protection of confidential
			 information; and biographical information for officers and directors. The
			 Department will accept the biographical affidavit, and any supplement to that
			 affidavit, that is obtained from the website of the National Association of
			 Insurance Commissioners (NAIC) or the Department.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2905 - REGISTRATION OF WORKERS' COMPENSATION UTILIZATION REVIEW ORGANIZATIONS › Section 2905.30 - Fees

Current through Register Vol. 48, No. 28, July 12, 2024
A workers' compensation utilization review organization must
				register with the Director every two years. A fee of $3,000 must be submitted
				with each application or renewal unless the utilization review organization is
				accredited under the Health Utilization Management Standards or the Workers'
				Compensation Utilization Management Standards of URAC (formerly Utilization
				Review Accreditation Commission), in which case the fee is
				$1500.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2905 - REGISTRATION OF WORKERS' COMPENSATION UTILIZATION REVIEW ORGANIZATIONS › Section 2905.40 - Material Changes

Current through Register Vol. 48, No. 28, July 12, 2024
Any material changes in the information filed pursuant to this
				Part shall be filed with the Director within 30 days after the change. Loss of
				accreditation status will require re-registration and payment of a $3000 fee
				pursuant to Sections
				2905.20 and
				2905.30.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2905 - REGISTRATION OF WORKERS' COMPENSATION UTILIZATION REVIEW ORGANIZATIONS › Section 2905.50 - Renewals and Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
a) If a renewal
			 application and fee are not received prior to the renewal date, the
			 registration will automatically expire and the utilization review organization
			 must re-register and pay a fee pursuant to Sections
			 2905.20 and
			 2905.30 of this Part in
			 order to conduct utilization review for workers' compensation services as
			 provided by Section 8.7 of the Workers' Compensation Act [820 ILCS
			 305/8.7 ].
b) If an application for registration or
			 renewal is denied under this Part, the applicant may appeal that denial by
			 requesting a hearing under the terms of Article 10 of the Illinois
			 Administrative Procedure Act [5 ILCS 100 /Art. 10] and 50 Ill. Adm. Code 2402.
			 A petition for hearing must be postmarked no later than 30 days from the date
			 of initial denial. A hearing shall be scheduled within 45 days after the
			 petition is filed with the Director. A decision by the Director shall be
			 rendered within 60 days after the close of the hearing.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2907 - INSURANCE OVERSIGHT DATA COLLECTION › Section 2907.10 - Purpose and Scope

Current through Register Vol. 48, No. 28, July 12, 2024
a) The purpose
			 of this Part is to establish content, form and data reporting requirements for
			 information required to be reported to the Director by Section 29.2(b) of the
			 Workers' Compensation Act [ 820 ILCS 305 ]. This Part also establishes the
			 medium by which this information shall be transmitted to the
			 Director.
b) This Part applies to
			 each company licensed to write workers' compensation insurance in this State
			 pursuant to Section 4, Class 2(d) of the Code. These procedures are applicable
			 to all workers' compensation insurance written by insurers licensed by the
			 State of Illinois. The data filings are not to include premiums received from,
			 or losses paid to, other insurers because of the reinsurance assumed by the
			 reporting insurers; nor shall any deductions be made by the reporting insurers
			 for premiums ceded to, or for losses recovered from, other insurers because of
			 the reinsurance ceded.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2907 - INSURANCE OVERSIGHT DATA COLLECTION › Section 2907.20 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Code" means the Illinois Insurance Code [ 215 ILCS 5 ].
"Department" means the Illinois Department of Insurance.
"Director" means the Director of the Illinois Department of
				Insurance.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2907 - INSURANCE OVERSIGHT DATA COLLECTION › Section 2907.30 - Reporting Requirement

Current through Register Vol. 48, No. 28, July 12, 2024
a) Scope of
			 Procedure
Each insurer licensed to write workers' compensation coverage
				in the State shall report to the Department information on an aggregate basis
				before March 1 of each year, relating to claims in the State opened within the
				prior calendar year.
b)
			 Specific data elements to be reported are defined in Appendix A.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2907 - INSURANCE OVERSIGHT DATA COLLECTION › Section 2907.40 - Coding Conventions for the Insurance Oversight Workers' Compensation Data Collection

Current through Register Vol. 48, No. 28, July 12, 2024
The data described in Section
				2907.30
				must be submitted to the Department electronically in a Comma Separated Values
				(.csv) format. A sample table illustrating the format of the data is included
				in Appendix B. A template for the data submission is available on the
				Department's website at
http://insurance.illinois.gov/
.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2907 - INSURANCE OVERSIGHT DATA COLLECTION › Appendix B - Sample Table

Current through Register Vol. 48, No. 28, July 12, 2024
a) Data File Format
The sample table in subsection (b) provides a list
				of the required data elements for illustrative purposes only. Do not submit
				your data in this format. All files must be submitted electronically as
				specified in Section
				2907.40.
				A template is available for use on the Department's website at
http://insurance.illinois.gov/
.
b) Sample Table
NAIC #
FEIN
Company Name
Company Contact Name
Company Contact Phone Number
Contact email
Claims Opened
Medical Claims
Contested Claims
FIELD: 1
FIELD: 2
FIELD: 3
FIELD: 4a
FIELD: 4b
FIELD: 5
FIELD: 6
FIELD: 7
FIELD: 8
Client-Attorney
Breakdown of lost
time by claim
Adjuster Person-Hours
Claims Paid Time Frame
Medical Payment Time Frame
FIELD
9
FIELD: 10a
FIELD: 10b
FIELD: 10c
FIELD: 11
FIELD: 12
FIELD: 13a
FIELD: 13b
Internal Defense Council
External Defense Council
Bill Review
Expenses
Fee Schedule Expenses
Managed Care Expenses
FIELD: 14a
FIELD 14b
FIELD: 15a
FIELD: 15b
FIELD: 16a
FIELD: 16b
FIELD: 17
FIELD: 18
Internal Medical
Nurse Management
External Medical Nurse Management
Medical Exam Expenses
Internal Utilization Review
						  Expenses
External Utilization Review
						  Expenses
FIELD: 19a
FIELD: 19b
FIELD: 20a
FIELD: 20b
FIELD: 21
FIELD: 22
FIELD: 23
Illinois Administrative Code › Title 50 - INSURANCE › Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING › Section 2908.10 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
Every employer and insurer, or the employer's or insurer's
				payer or payer's agent, and every third party administrator must accept
				electronic claims for payment of medical services as provided by Section 8.2 a
				of the Act. Every health care provider or facility rendering treatment pursuant
				to the Act must submit medical bills for payment on standardized forms either
				electronically or on paper as provided by Section 8.2a of the
				Act.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING › Section 2908.20 - Purpose and Scope

Current through Register Vol. 48, No. 28, July 12, 2024
Subject to Section 8.2 a of the Act, the purpose of this Part
				is to set forth the requirements for electronic billing, processing and payment
				of medical and facility services, treatments and products and to adopt
				standardized forms provided to an injured employee.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING › Section 2908.40 - Formats for Electronic Medical Bill Processing

Current through Register Vol. 48, No. 28, July 12, 2024
a) For electronic transactions, the following
			 electronic medical bill processing standards shall be used:
1) Billing:
A) Professional Billing -
The ASC X12 Standards for Electronic Data Interchange Technical
				Report Type 3, Health Care Claim: Professional (837), May 2006, ASC X12,
				005010X222 (no later amendments or editions); and Type 3 Errata to Health Care
				Claim: Professional (837), June 2010, ASC X12, 005010X222A1 (no later
				amendments or editions);
B)
			 Institutional/Hospital Billing -
i) The ASC
			 X12 Standards for Electronic Data Interchange Technical Report Type 3, Health
			 Care Claim: Institutional (837), June 2010, ASC X12N/005010X223 (no later
			 amendments or editions);
ii) Type 1
			 Errata to Health Care Claim: Institutional (837), ASC X12 Standards for
			 Electronic Data Interchange Technical Report Type 3, October 2007, ASC
			 X12N/005010X223A1 (no later amendments or editions); and
iii) Type 3 Errata to Health Care Claim:
			 Institutional (837), June 2010, ASC X12, 005010X223A2 (no later amendments or
			 editions);
C) Dental
			 Billing -
i) The ASC X12 Standards for
			 Electronic Data Interchange Technical Report Type 3, Health Care Claim: Dental
			 (837), June 2010, ASC X12N/005010X224 (no later amendments or
			 editions);
ii) Type 1 Errata to
			 Health Care Claim: Dental (837), ASC X12 Standards for Electronic Data
			 Interchange Technical Report Type 3, October 2007, ASC X12N/005010X224A1 (no
			 later amendments or editions); and
iii) Type 3 Errata to Health Care Claim:
			 Dental (837), June 2010, ASC X12, 005010X224A2 (no later amendments or
			 editions);
D) Retail
			 Pharmacy Billing -
i) The Telecommunication
			 Standard Implementation Guide, Version D, Release 0 (Version D.0), August 2007,
			 National Council for Prescription Drug Programs, 9240 East Raintree Drive,
			 Scottsdale AZ 85260, July 2012 (no later amendments or editions); and
ii) The Batch Standard Batch Implementation
			 Guide, Version 1, Release 2 (Version 1.2 ), January 2006, National Council for
			 Prescription Drug Programs, 9240 East Raintree Drive, Scottsdale AZ 85260, July
			 2012 (no later amendments or editions).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING › Section 2908.50 - Billing Code Sets

Current through Register Vol. 48, No. 28, July 12, 2024
All billing codes and modifier systems used for electronic
				billing shall be in accordance with 50 Ill. Adm. Code 9110.90 (Illinois
				Workers' Compensation Commission Medical Fee Schedule). Billing codes and
				modifier systems identified in this Section are valid codes for the specified
				workers' compensation transactions, in addition to any code sets defined by the
				standards adopted in the Workers' Compensation Act [820 ILCS 305 ] and 50 Ill.
				Adm. Code 9110.90.
a) "CDT-4 Codes" -
			 codes and nomenclature prescribed by the American Dental Association, as
			 published in CDT 2015: Dental Procedure Codes, September 2014, American Dental
			 Association, 211 East Chicago Ave., Chicago IL 60611-2678, website
http://www.ada.org/en/
(no later
			 amendments or editions).
b) "CPT-4
			 Codes" - the procedural terminology and codes contained in the "Current
			 Procedural Terminology, Fourth Edition", as published by the American Medical
			 Association (AMA) and as adopted in the appropriate fee schedule contained in
			 50 Ill. Adm. Code 9110.90.
c)
			 "Diagnosis Related Group" or "DRG" - the inpatient classification scheme used
			 by CMMS for hospital inpatient reimbursement. The DRG system classifies
			 patients based on principal diagnosis, surgical procedure, age, presence of
			 co-morbidities and complications, and other pertinent data. (See 42 CFR
			 412.)
d) "HCPCS" - CMMS' Healthcare
			 Common Procedure Coding System, a coding system that describes products,
			 supplies, procedures and health professional services and that includes AMA's
			 CPT-4 codes, alphanumeric codes, and related modifiers.
e) "ICD-9-CM Codes" - diagnosis and procedure
			 codes in the International Classification of Diseases,
			 9th Revision, Clinical Modification, published by
			 HHS.
f) "ICD-10-CM/PCS Codes" -
			 diagnosis and procedure codes in the International Classification of Diseases,
			 10th Edition, Clinical Modification/Procedure Coding
			 System, maintained and published by HHS.
g) "NDC" - National Drug Codes of the United
			 States Food and Drug Administration. (See Section 510 of the Federal Food,
			 Drug, and Cosmetic Act (
			 21 USC
			 360 ).)
h) "Revenue Codes" - the 4-digit coding
			 system developed and maintained by the National Uniform Billing Committee
			 (NUBC) for billing inpatient and outpatient hospital services, home health
			 services, and hospice services. The revenue codes are contained in the Official
			 UB-04 Data Specifications Manual 2016 (Manual 2016), July 2015, National
			 Uniform Billing Committee, website
http://www.nubc.org/
(no later amendments or
			 editions).
i) "National Uniform
			 Billing Committee Codes" - code structure and instructions established for use
			 by NUBC, such as occurrence codes, condition codes, or prospective payment
			 indicator codes. These are known as UB-04 codes and are contained in Manual
			 2016.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING › Section 2908.60 - Electronic Medical Billing, Reimbursement and Documentation

Current through Register Vol. 48, No. 28, July 12, 2024
a) Applicability
1) This Section outlines the exclusive
			 process for the initial exchange of electronic medical bill and related payment
			 processing data for professional, institutional/hospital, pharmacy and dental
			 services. This Section does not apply when a hospital, physician, surgeon or
			 other person rendering treatment pursuant to the Act is submitting a
			 standardized form on paper in conformity with 50 Ill. Adm. Code 2017 (Uniform
			 Medical Claim and Billing Forms) as applicable to the service rendered or
			 responding to requests for reconsideration or judicial appeals concerning any
			 matter related to medical compensation or requests for informational copies of
			 medical records.
2) Unless exempted
			 from this process in accordance with subsection (m), payers or their agents
			 shall:
A) Accept electronic medical bills
			 submitted in accordance with the standards set forth in this Part;
B) Transmit acknowledgments and remittance
			 advice in compliance with this Part, in response to electronically submitted
			 medical bills; and
C) Support
			 methods to receive electronic documentation required for the adjudication of a
			 bill, as described in Section
			 2908.90.
3) Before accepting an electronically
			 submitted medical bill, the payer shall ensure that the medical provider or
			 clearing house:
A) has implemented a software
			 system capable of exchanging medical bill data in accordance with the adopted
			 standards or has contracted with a clearinghouse to exchange its medical bill
			 data;
B) is able to submit medical
			 bills in accordance with Section
			 2908.40(a)(1)
			 to the payer and has established connectivity between the payer and the health
			 care provider's or clearinghouse's system;
C) can submit required documentation in
			 accordance with this Part; and
D)
			 can receive and process any acceptance or rejection acknowledgment from the
			 payer.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING › Section 2908.70 - Employer, Insurance Carrier, Managed Care Organization or Agents' Receipt of Medical Bills from Health Care Providers

Current through Register Vol. 48, No. 28, July 12, 2024
a) Upon receipt of medical bills submitted in
			 accordance with Sections
			 2908.30,
			 2908.40
			 and
			 2908.50, a
			 payer shall evaluate each bill's conformance with the criteria for a complete
			 medical bill set forth in Section 8.2(d) of the Act.
1) A payer shall not reject medical bills
			 that are complete, unless the bill is a duplicate bill.
2) Within 21 calendar days after receipt of
			 an incomplete medical bill, a payer or its agent shall either:
A) Complete the bill by adding missing health
			 care provider identification or demographic information already known to the
			 payer; or
B) Reject the incomplete
			 bill in accordance with this subsection (a).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING › Section 2908.80 - Communication Between Health Care Providers and Payers

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any communication between the health care
			 provider and the payer related to medical bill processing shall be of
			 sufficient specific detail to allow the responder to easily identify the
			 information required to resolve the issue or question related to the medical
			 bill. Generic statements that simply state a conclusion, including, but not
			 limited to, "payer improperly reduced the bill" or "health care provider did
			 not document" or other similar phrases with no further description of the
			 factual basis for the sender's position, do not satisfy the requirements of
			 this Section.
b) The payer's
			 utilization of the Claim Adjustment Group Codes, Claim Adjustment Reason Codes,
			 and/or the Remittance Advice Remark Codes, or as appropriate, the NCPDP
			 Reject/Payment Codes, specified in Section
			 2908.60(e)(3),
			 when communicating with the health care provider or its agent or assignee
			 through the use of the 835 transaction, provides a standard mechanism to
			 communicate issues associated with the medical bill.
c) Communication between the health care
			 provider and payer related to medical bill processing shall be made by
			 telephone or secured electronic transmission unless the information cannot be
			 sent by those media, in which case the sender shall send the information by
			 first class mail or personal delivery.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING › Section 2908.90 - Medical Documentation Necessary for Billing Adjudication

Current through Register Vol. 48, No. 28, July 12, 2024
a) Medical
			 documentation includes all medical reports and records permitted or required in
			 accordance with the Act.
b)
			 Requests for medical reports shall be accompanied by releases from the
			 patient.
c) Any request by the
			 payer for additional documentation to process a medical bill shall conform to
			 the requirements of Section
			 2908.70(c).
d) It is the obligation of an insurer or
			 employer to furnish its agents with any documentation necessary for the
			 resolution of a medical bill.
e)
			 Payers shall take reasonable steps to ensure that health care providers, health
			 care facilities, third-party biller/assignees, and claims administrators and
			 their agents comply with all applicable federal and State rules related to
			 privacy, confidentiality and security.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2908 - WORKERS' COMPENSATION ELECTRONIC AND STANDARDIZED PAPER BILLING › Section 2908.100 - Administrative Fines

Current through Register Vol. 48, No. 28, July 12, 2024
a)
The
			 Department shall impose an administrative fine if it determines that a payer
			 has failed to comply with the electronic claims acceptance and response
			 process
required by this Part or by the Act.
The amount of the
			 administrative fine shall be no greater than $1,000 per violation and shall not
			 exceed $10,000 for identical violations during a calendar year.
[ 820
			 ILCS 305/8.2a(a)(7) ]
b) The amount
			 of the fine assessed for each violation by the payer or payer agent shall be as
			 follows:
1) For the first violation of an
			 applicable requirement within a calendar year, $300;
2) For a second, identical violation within
			 the same year, $700; and
3) For
			 each additional, identical violation within the same year, $1,000.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2909 - WORKERS' COMPENSATION LARGE DEDUCTIBLE BUSINESS › Section 2909.10 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
This Part applies to every insurer as defined in Section
				155.44(b) of the Code that issues "large deductible agreements" as defined in
				Section 155.44(c) of the Code and that does not meet the definition of "exempt
				insurer" (see Section 2909.30 ).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2909 - WORKERS' COMPENSATION LARGE DEDUCTIBLE BUSINESS › Section 2909.20 - Purpose and Scope

Current through Register Vol. 48, No. 28, July 12, 2024
Subject to Section 155.44 of the Code, the purpose of this Part
				is to set forth the requirements for maintaining collateral and underwriting
				large deductible workers' compensation insurance by nonexempt
				insurers.