Workers, employers and health care providers all are looking for guidance on the new worker’s compensation law reform in Illinois, but experts say it will take time--maybe through 2016-- to really understand the effects.

What is clear, however, is that those on both sides of the issue still have concerns and that suggests there will be more changes to the law; though exactly what those will be is a mystery too. But the consensus seems to be everyone is long on questions and short on understanding the practical ramifications of the new legislation signed into law by Gov. Pat Quinn on June 28. The law is designed to take effect in stages over the next several years.

“We just don’t know what this is all going to mean,’’ said IL Rep. Ken Dunkin, (D-5), who believes there will be many more tweaks to the law before it’s over and held a recent panel discussion that included insurance officials and workers’ comp attorneys and was heavily attended by physicians. “There is huge room for modifications. The rest is up to us.’’

Added Steven Seidman, a workers’ comp attorney representing employers: “We’re not going to know what this all does for about five years.’’

The panel discussion was frank and candid, with the most complaints stemming from doctors in attendance, all of whom felt the bill's 30 percent cut in physician fees left them with too much of the burden. Rep. Dunkin told them their lobbyists “were not as effective as they could have been.’’

The reform was enacted because Illinois has the second highest workers’ compensation costs in the nation -- $3 billion in 2010 -- and numerous instances of fraud and abuse have come to light in recent years. Experts say the measure should save the state $500 million to $700 million a year.

Nobody thinks there will be any immediate impact on workers filing claims, however.

“They are going to get the care they need and get it in a timely fashion,’’ said Gene Keefe, a worker’s compensation attorney representing injured workers. “It’s already a slow-moving system, I don’t think any of the parties involved will see a significant change.’’

Doctors, though, say their concerns go beyond their own finances and will reduce the quality of care workers get, in part because many doctors may turn down workers’ comp patients. Under the new law, doctors also have to be responsive to requests for reports and interviews from state officials or risk forfeiting payment on a patient.

The reform, however, does require the State to accept electronic billing and compels medical providers to establish standardized forms, which should mean health care providers will see payments much faster than they do now.

This “is really a plan to undercut funding for injured workers’ medical care. These cuts mean fewer health professionals treating workers’ compensation patients, longer waits for care and non-existent savings for business,’’ said Dr. Wayne V. Polek, president of the Illinois State Medical Society. “Any alleged ‘savings’ will be offset by higher business expenses due to workers waiting longer for care and delaying their return to work.

Doctors who attended Dunkin’s forum echoed Polek’s position.

“I’ve got fewer options for an employee to get them into see someone because some specialist surgeons have told me they won’t take these cases any longer,’’ said Dr. Edward J. Pillar who runs Excel Occupational Health Clinic in Bedford Park. “And from an employer standpoint, they want their people back to work. But if I can’t get them in to see an orthopedic surgeon for a month, it’s going to take longer for them to return to the job.’’

Adding insult to injury for Pillar: his insurance agent told him not to expect any significant decrease in the rate he pays for workers’ compensation insurance for his employees.

But Keefe said the law simply adjusts cases to pay the same as other injuries, and the state has been subsidizing above-market rates for doctors for years.

“Why should it cost 30 percent more because a guy broke his ankle slipping on oil in a warehouse than if he breaks his ankle sliding into second base?’’ he asked. His prediction: “Doctors are going to suck it up and take what’s being offered. If they spend a few extra hours on a case talking to investigators, they can bill for it.’’

Some key provisions of the bill are:

• Payment schedule – Doctors and other medical professionals will take a 30 percent reduction in rates paid on workers’ compensation cases. While advocates say this will bring payments in line with other medical treatments, critics say workers’ comp cases are more complicated and require more time due to a heavier paperwork burden and greater scrutiny of the cases, often resulting in doctors having to give depositions and testify at hearings.
• Creation of Preferred Provider Plans – Employers can create preferred provider plans, which builds a network of doctors and other medical professionals for employees to consult. An injured employee can see two doctors in the network before deciding on care. If the employee opts out of the network, which must be done in writing in advance of an injury, he’s only allowed to see one doctor. If an employee is unhappy with the opinions of the two network doctors or the one outside doctor, he would have to go to a hearing and prove a need for another medical opinion. This is done both to create a controlled and predictable fee structure in the PPP network, but also to limit the practice of doctor shopping – patients going from one doctor to another until they find the one whose diagnosis is the most profitable or offers the most time away from work.
• Reform of abuse and misconduct – The law increases the criminal penalties for workers’ compensation fraud and the Fraud and Insurance Non-compliance unit to develop a computer modeling system that uses social networking, data mining and other advanced computer processes to prevent and prosecute fraud.
• Retention of arbitrators – All of the state’s workers’ comp arbitrators had their jobs terminated as of July 1, but remain in their posts on an interim basis until they are re-appointed or a replacement is assigned. The law also creates tougher standards for arbitrators, subjecting them to greater review and assuring that cases are randomly assigned. Additionally, arbitrators will spend no more than two years in any one location to ensure they don’t become beholden to outside interests.
• Intoxication – Employees will be subject to blood, urine and other testing after an injury and evidence of intoxication will create a presumption that the drug or alcohol use was the cause of the accident.

Image: Resource Insurance Group