Docs slam, biz applauds Rauner workers’ comp AV
Wednesday, Aug 29, 2018 - Posted by Rich Miller
* Rauner veto message…
SB 904, as approved by the General Assembly, proposes changes to the Workers’ Compensation Act to: 1) provide to medical providers a mechanism for collection of the 1% per month interest penalty provided by Section 8.2 of the Act; and 2) provide penalties for the Department of Insurance enforcement of the electronic claims transaction requirements under the Act.
This Administration has advocated since taking office the need for reform of our workers’ compensation system to provide relief to employers from the high costs of our system. Unfortunately, the majorities in the General Assembly have sent to me legislation that does not provide the changes needed to bring our workers’ compensation costs in line with other states. Failure to work with our business community, legislators supporting reform, and my office to enact meaningful reform has resulted in the maintaining of our high costs, which are driving high wage jobs with good benefits out of our state.
SB 904 is not reform, does nothing to assist injured workers and dramatically tips the balance in favor of medical providers in a system where Illinois has the second highest medical fee schedule in the country for overall professional services and the highest in the country for major surgery services. Furthermore, SB 904 diminishes an employer’s ability to determine causation and whether an injury is work-related.
A much more balanced approach is necessary to meet the bill’s purpose and to reduce the friction in the billing and payment of medical bills in our workers’ compensation system. Rather than creating lengthy disputes in our court system, I propose a procedure through the Illinois Workers’ Compensation Commission which would result in more timely determinations of interest payments for all concerned. Furthermore, this administration is dedicated to the proper enforcement of the Insurance Code, and the Department of Insurance will be issuing guidance on compliance with the relevant law.
* That line about how the bill “dramatically tips the balance in favor of medical providers” didn’t go over well with the docs…
Illinois physicians are deeply disappointed by Governor Rauner’s amendatory veto of Senate Bill 904, which included important bipartisan protections within the workers’ compensation system. The Governor’s action gives workers’ comp insurance companies continuing latitude to skirt current law on payment of workers’ compensation claims. Quality medical care is key to reducing workplace injuries and getting injured workers back to work. This is an important benefit to both the injured worker and the employer.
We consider Governor Rauner’s amendatory veto of SB 904 a huge setback for the medical community, employers and injured workers. The important care provided by doctors, hospitals, and other providers is threatened because of a loophole being exploited by workers’ compensation insurance companies that allows them to authorize treatment and then not pay a medical provider, which can stretch as long as three years.
This loophole is so egregious that even the Illinois Appellate Court sent a notice to the Illinois Department of Insurance about the questionable practices of Illinois workers compensation insurance companies.
Right now, doctors in Illinois are owed millions of dollars for approved workers’ compensation medical care. We know of one medical practice that is currently owed $24 million in pre-authorized claims. Senate Bill 904 would avoid the bureaucracy of the Illinois Workers’ Compensation Commission and allow for a right of action in Circuit Court to collect those amounts receivable with an interest penalty, a right that was written into the law in 2005 and agreed to by the business community.
By rejecting SB 904, Governor Rauner also allows insurers to continue ignoring mandatory electronic billing requirements enacted in 2011. These insurers are clinging to an all-paper based billing system that delays care and payments.
ISMS thanks the members of the General Assembly for passing SB 904 by an overwhelming margin. On behalf of Illinois physicians and the injured workers we serve, ISMS will seek an override of this amendatory veto.
* When it comes to workers’ comp, there are three competing interest groups: business, unions and medical providers. Sometimes, biz and labor team up to whack the docs, sometimes labor and the docs turn on business. Sometimes, when everybody works together, all three agree to a haircut. They didn’t all work together this time. Here’s the Illinois Manufacturers’ Association…
“The IMA applauds Governor Rauner for stopping an attempt to significantly increase the cost of workers’ compensation for Illinois employers that already face the 8th highest costs in the nation,” said Mark Denzler, Vice President and COO of the Illinois Manufacturers’ Association. “This legislation sought to impose draconian new penalties on job creators while also limiting information that could be used to determine whether an injury was caused by the workplace. Lawmakers need to address the structural inequities in the system, including creation of a primary cause standard, creation of a drug formulary, use of American Medical Association standards, and reigning in medical costs. It makes absolutely no sense that a doctor can charge 350 percent more for performing the exact same surgery under workers’ compensation that they would receive under private insurance
- wordslinger - Wednesday, Aug 29, 18 @ 9:42 am:
–The important care provided by doctors, hospitals, and other providers is threatened because of a loophole being exploited by workers’ compensation insurance companies that allows them to authorize treatment and then not pay a medical provider, which can stretch as long as three years.–
That’s Rauner’s kind of loophole. He’s a slow-play/no-pay kind of guy.
- JS Mill - Wednesday, Aug 29, 18 @ 9:51 am:
So, basically the governor is saying it is ok for insurance companied to stiff doctors who provide medical services to workers comp claimants? Very pro bidness’/s
Doctors have to float a ton of costs dealing with insurance companies in general, insurance companies should pay in a timely manner.
- Trapped in the 'burbs - Wednesday, Aug 29, 18 @ 9:52 am:
Alienating wealthy, well organized groups of voters doesn’t seem like a great re-election strategy.
- Annonin' - Wednesday, Aug 29, 18 @ 10:06 am:
GovJUnk sides with IMA and big insurance — surprise.
One might think that medical related employment is on the rise he might want to think helping this industry as a way to “grow jobs”
Guess this is not simple enough
- Lester Holt’s Mustache - Wednesday, Aug 29, 18 @ 10:41 am:
Glad to see Rauner still can’t bring himself to accept a bill he doesn’t really desire but could allow him to publicly declare victory. I was beginning to think he’d become smart enough to learn from his own mistakes.
“Why would I want doctors on my side when I could have insurance company executives instead?”
- 47th Ward - Wednesday, Aug 29, 18 @ 10:41 am:
I remember when the Med Society was tied at the hip with the HGOPs. They rivaled ISRA as a lobbying force in the Capitol back in the 1990s.
When doctors can’t persuade Republicans you know something fundamental has changed in politics.
- BlueDogDem - Wednesday, Aug 29, 18 @ 10:46 am:
This governor is desperate to show he has accomplished something. This gesture is meaningless.
- Louis G. Atsaves - Wednesday, Aug 29, 18 @ 11:02 am:
Now for my rant.
Crazy stuff when the IMA is basically siding with injured workers and those who employ them over a provision that will screw up Workers’ Compensation and exacerbate delays of benefits to injured workers.
The Amendatory Veto basically prevents medical providers from directly filing suit in their local circuit courts in pending Workers’ Compensation cases to get the penalty fee of 1% for late payments and to order payment of bills. This while the case is still pending at the Illinois Workers’ Compensation Commission? Confused? Consider some more facts:
The IWCC runs an administrative court system that is supposed to be simple and summary in nature, which includes determining which medical bills relate to treatment for the injury, which ones represent reasonable and necessary medical care, and which ones are not related and do not represent reasonable and unnecessary care. This creates a complicated mess that is neither simple nor summary. And the medical providers hate it. Well so do just about everyone else involved in WC in Illinois.
So how does it benefit the injured worker or his/her employer to create chaos in a litigation system that will ultimately further delay payment of benefits to injured workers? By having two competing court systems simultaneously adjudicating medical bills using the current legal standards? Good luck with that one.
The parties should and must sit down and negotiate a solution, rather than ramming something down everyone’s throats which solves nothing and which will ultimately exacerbate problems in WC cases. I know I’m talking to the wall and hearing an echo response, and have been for the past few years, but a lot of problems in WC cases can be fixed without screwing one or both sides, or without the politics of refusing to give anyone a win.
The Commission in the meantime has quietly and significantly reduced their backlog of cases according to their last four annual reports, but these guys want the right to immediately go the circuit court instead and file a second action? Huh? What? Eh?
And the Commission quietly reduced those prior backlogs basically without the assistance of badly needed legislation bogged down in politics which would have fairly sped the process up instead of bogging it down with cases assigned to geographical zones and constantly revolving Arbitrators. Don’t believe me? Check out what is in the Act.
Sheesh.
For all you Rauner haters out there, Rauner made the correct move here. The bill invites chaos and more delays. It makes the problem worse.
Tell the warring parties to grow up and sit down and talk to each other to come up with a reasonable solution to this problem, and a lot of other problems dogging the current Illinois WC Act.
Rant over.
- Lucky Pierre - Wednesday, Aug 29, 18 @ 11:03 am:
* When it comes to workers’ comp, there are three competing interest groups: business, unions and medical providers.
There are actually 4, don’t forget about the power trial lawyers, who always win in Illinois
- Rich Miller - Wednesday, Aug 29, 18 @ 11:29 am:
=== don’t forget about the power trial lawyers===
They’re almost always in step with the unions, but yeah, you’re right.
- Deadbeat Conservative - Wednesday, Aug 29, 18 @ 11:50 am:
=They’re almost always in step with the unions, but yeah, you’re right.=
Those pesky people advocating due process and rule of law.
- BlueDogDem - Wednesday, Aug 29, 18 @ 12:10 pm:
Deadbeat. We need to change the rule of law.
- logic not emotion - Wednesday, Aug 29, 18 @ 1:24 pm:
Work comp is a complicated mess.
I personally know of one person (an over the road trucker) who received it for a purported shoulder injury despite being on video repeatedly lifting and carrying 80 pound wood sections significant distances.
I also personally know of someone who deserved work comp, got the total run around, ended up paying for multiple related surgeries out of his own pocket, and lost his job.
- Demoralized - Wednesday, Aug 29, 18 @ 1:27 pm:
==We need to change the rule of law.==
No idea what that means (and I suspect you don’t either).
- the Patriot - Wednesday, Aug 29, 18 @ 1:32 pm:
You can fix work comp with a a one sentence bill and Rauner knows it. Simply tie insurance premiums to actual costs.
The legislature was told this in 2011, they have been told it repeatedly since. You don’t need a slide rule to understand why Rauner won’t hold Insurance companies accountable as they rake profits.
What no one has explained to me is why won’t Madigan? You can cut 15% off work comp premiums without cutting workers, doctors, or lawyers.
- Alternative Logic - Wednesday, Aug 29, 18 @ 3:55 pm:
== I personally know of one person… ==
I personally know of one person who rightly said, “The plural of anecdote isn’t data.”
—
When (Increasing) Big Medicine is caught in interlocking fire with Big Insurance that a failure of leadership by the Illinois Chamber.
- anon - Wednesday, Aug 29, 18 @ 10:09 pm:
the hospitals are key members of the chamber of commerce in every community in the state and they are getting real tired of playing second fiddle to the insurance industry–maybe health care needs its own biz group since they are the largest employer in the state.