Recent changes to the Illinois Workers Compensation Act

One of the most important changes involves the injured worker’s choice of doctor. The new amendments to the Act allow employers to establish Preferred Provider Programs (PPPs) and changes the way employees are allowed to choose their treating medical providers. Formerly, the employer was responsible for all first aid and emergency services, two treating doctors of the employee’s choice and any additional providers to which the employee is referred by the two treating doctors. However, under the newly amended Act:

• The number of treating physicians allowed depends on whether the employer is enrolled in a Preferred Provider Program, or PPP. A PPP establishes a group of doctors and medical providers that have been approved by a particular employer to treat its workers.
• If the employer is not enrolled in a PPP, an injured worker will have the right to seek medical treatment from up to two doctors of his choosing and any medical providers he is referred to by those two doctors.
• However, if the employer is enrolled in a PPP, an injured worker must decide to “opt in” or “opt out” of the employer’s PPP. If the employee opts in to the program, he can seek treatment from up to two of the listed medical providers and any providers he is referred to by the two chosen providers. If the commission finds that the second choice of doctor within the employer’s PPP network has not provided adequate treatment, the employee may then choose a doctor from outside the network.
• If, on the other hand, the employee opts out of the program, he is limited to only one doctor of his choosing and any providers he is referred to by that doctor. In essence, the choice to opt out of the program will be considered one of the employee’s two “choices” of doctor.
• Note: Emergency first aid is not considered one of the employee’s choices of doctors. However, if, before reporting an injury, an employee receives non-emergency treatment by a doctor who is not on the employer’s PPP list, this will be considered the employee’s one choice of doctor and the employee will not be allowed another.
• If an employee wants to see a third doctor, he or she may do so at his or her own expense. The employer may approve a third doctor but is not obligated to pay for the treatment.