ILLINOIS
Employee Selects
The employee may at any time elect to secure his own physician, surgeon and hospital services at the employer's expense. (820 ILCS 305/8(a))

Notwithstanding the foregoing, the employer's liability to pay for such medical services selected by the employee shall be limited to: (1) all first aid and emergency treatment; plus (2) all medical, surgical and hospital services provided by the physician, surgeon or hospital initially chosen by the employee or by any other physician, consultant, expert, institution or other provider of services recommended by said initial service provider or any subsequent provider of medical services in the chain of referrals from said initial service provider; plus (3) all medical, surgical and hospital services provided by any second physician, surgeon or hospital subsequently chosen by the employee or by any other physician, consultant, expert, institution or other provider of services recommended by said second service provider or any subsequent provider of medical services in the chain of referrals from said second service provider. Thereafter the employer shall select and pay for all necessary medical, surgical and hospital treatment and the employee may not select a provider of medical services at the employer's expense unless the employer agrees to such selection. At any time the employee may obtain any medical treatment he desires at his own expense. This paragraph shall not affect the duty to pay for rehabilitation referred to above. (4) The following shall apply for injuries occurring on or after June 28, 2011, and only when an employer has an approved PPP pursuant to 820 ILCS 305/8.1a on the date the employee sustained his or her accidental injuries: (A) The employer shall, in writing, on a form promulgated by the Commission, inform the employee of the PPP; (B) Subsequent to the report of an injury by an employee, the employee may choose in writing at any time to decline the PPP, in which case that would constitute one of the two choices of medical providers to which the employee is entitled under subsection (a)(2) or (a)(3); and (C) Prior to the report of an injury by an employee, when an employee chooses non-emergency treatment from a provider not within the PPP, that would constitute the employee's one choice of medical providers to which the employee is entitled under subsection (a)(2) or (a)(3). ((820 ILCS 305/8(a)(1) - (4))

Employee Selects from Panel
Upon agreement between the employer and employees, or the employees' exclusive representative, and subject to the approval of the IL Workers' Compensation Commission, the employer shall maintain a list of physicians to be known as a Panel of Physicians, who are accessible to the employees. (820 ILCS305/8(a))

Change of Provider
The employee may make one change of provider without authorization. Thereafter the employer shall select and pay for all necessary medical, surgical and hospital treatment and the employee may not select a provider of medical services at the employer's expense unless the employer agrees to such selection. (820 ILCS 305/8(a))

When an approved panel is in use, the employee shall have the right to make an alternative choice of physician from the Panel if he is not satisfied with the physician first selected. (820 ILCS 305/8(a))

Panels
Not allowed unless approved by the IL WCC

Panel Provisions
Upon agreement between the employer and the employees, or the employees' exclusive representative, and subject to the approval of the Illinois Workers' Compensation Commission, the employer shall maintain a list of physicians, to be known as a Panel of Physicians, who are accessible to the employees. The employer shall post this list in a place or places easily accessible to his employees. (820 ILCS 305/8(a))

In previous discussions with IL regulators, the state has advised that petitions to use panels of physicians are rare. There is no standard form for submitting a petition. Only a Commissioner can determine whether the petition/form is appropriate and complete and only a Commissioner may approve a petition for use of panels.

ILLINOIS PPP
Employee Selects from Network
Starting on June 28, 2011, to satisfy its liabilities under the Workers' Compensation Act for the provision of medical treatment, an employer may utilize a preferred provider program (PPP) approved by the Illinois Department of Insurance. (820 ILCS 305/8.1a)

Except for the provisions of 820 ILCS 305/8(a)(4), and for injuries occurring on or after 6/28/11, an employee of an employer utilizing a PPP shall only be allowed to select a participating network provider from the network. An employer shall be responsible for: (i) all first aid and emergency treatment; (ii) all medical, surgical, and hospital services provided by the participating network provider initially selected by the employee or by any other participating network provider recommended by the initial participating network provider or any subsequent participating network provider in the chain of referrals from the initial participating network provider; and (iii) all medical, surgical, and hospital services provided by the participating network provider subsequently chosen by the employee or by any other participating network provider recommended by the subsequent participating network provider or any subsequent participating network provider in the chain of referrals from the second participating network provider. (820 ILCS 305/8.1a(c))

When the injured employee notifies the employer of the injury or files a claim for workers' compensation with the employer, the employer shall notify the employee of his or her right to be treated by a physician of his or her choice from the PPP established pursuant to this Section, and the method by which the list of participating network providers may be accessed by the employee, except as provided in subsection (a)(4) of Section 8. (820 ILCS 305/8.1a(c)(1))

Consistent with Article XX-1/2 of the Illinois Insurance Code, treatment by a specialist who is not a member of the preferred provider network shall be permitted on a case-by-case basis if the medical provider network does not contain a physician who can provide the approved treatment, and if the employee has complied with any pre-authorization requirements of the preferred provider network. Consent for the employee to visit an out-of-network provider may not be unreasonably withheld. When a non-network provider is authorized pursuant to this subparagraph (2), the non-network provider shall not hold an employee liable for costs except as provided in subsection (e) of Section 8.2 [820 ILCS 305/8.2]. (820 ILCS 305/8.1a(c)(2))

Subsequent to the report of an injury by an employee, the employee may choose in writing at any time to decline the PPP, in which case that would constitute one of the two choices of medical providers to which the employee is entitled under subsection (a)(2) or (a)(3) of 820 ILCS 305/8 (Non-PPP) ; and (C) Prior to the report of an injury by an employee, when an employee chooses non-emergency treatment from a provider not within the PPP, that would constitute the employee's one choice of medical providers to which the employee is entitled under subsection (a)(2) or (a)(3) of 820 ILCS 305/8 (Non-PPP) (§ 820 ILCS 305/8 (4)(B) & (C)

Each administrator shall provide to each beneficiary of any program subject to this Article a document which (1) sets forth those providers with which agreements or arrangements have been made to provide health care services to such beneficiary, a source for the beneficiary to contact regarding changes in such providers and a clear description of any incentives for the beneficiary to utilize such providers, (2) discloses the extent of coverage as well as any limitations or exclusions of health care services under the program, (3) clearly sets out the circumstances under which reimbursement will be made to a beneficiary unable to utilize the services of a provider with which an arrangement or agreement has been made, (4) a description of the process for addressing a beneficiary complaint under the program, and (5) discloses deductible and coinsurance amounts charged to any person receiving health care services from such a provider. (215 ILCS 5/370m - adopted by citing reference at § 820 ILCS 305/8.1a)

Change of Provider
An employer shall be responsible for: (i) all first aid and emergency treatment; (ii) all medical, surgical, and hospital services provided by the participating network provider initially selected by the employee or by any other participating network provider recommended by the initial participating network provider or any subsequent participating network provider in the chain of referrals from the initial participating network provider; and (iii) all medical, surgical, and hospital services provided by the participating network provider subsequently chosen by the employee or by any other participating network provider recommended by the subsequent participating network provider or any subsequent participating network provider in the chain of referrals from the second participating network provider. (820 ILCS 305/8.1a(c))

Except as provided in 820 ILCS 305/8(a)(4), upon a finding by the Commission that the care being rendered by the employee's second choice of provider within the employer's network is improper or inadequate, the employee may then choose a provider outside of the network at the employer's expense. The Commission shall issue a decision on any petition filed pursuant to this Section within 5 working days. (820 ILCS 305/8.1a(d))

Panels
Not addressed

Panel Provisions
See Direction of Care law for network access requirements.

The information on this website constitutes summary information only and does not constitute legal advice. Review of the full text of the referenced statutes and regulations may be necessary. Coventry Health Care Workers' Compensation, Inc. makes no representations or warranties about the accuracy of the information contained on this website.