(820
ILCS 305/25) (from Ch. 48, par. 138.25)
Sec.
25. The invalidity of any portion of this Act shall in no way affect
the validity of any other portion thereof which can be given effect
without such invalid part.
If
any of the provisions of this Act providing for compensation for
injuries to or death of employees shall be repealed or adjudged
invalid or unconstitutional, the period intervening between the
occurrence of any injury or death and such repeal or final adjudication
of invalidity, shall not be computed as a part of the time limited
by law for the commencement of any action relating to such injury
or death, but the amount of any compensation which may have been
paid for any such injury shall be deducted from any judgment for
damages recovered on account of such injury. Any claims, disagreement
or controversy existing or arising under "An Act to promote
the general welfare of the people of this State by providing compensation
for accidental injuries or death suffered in the course of employment
within this State, and without this State where the contract of
employment is made within this State; providing for the enforcement
and administering thereof, and a penalty for its violation, and
repealing an Act entitled, 'An Act to promote the general welfare
of the people of this State by providing compensation for accidental
injuries or death suffered in the course of employment', approved
June 10, 1911; in force May 1, 1912", approved June 28, 1913,
as amended, shall be adjusted in accordance with the provisions
of said Act, notwithstanding the repeal thereof, or may by agreement
of the parties be adjusted in accordance with the method of procedure
provided in this Act for the adjustment of differences, jurisdiction
to adjust such differences so submitted by the parties being hereby
conferred upon the Commission.
(Source: P.A.
83-1125.)
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(820
ILCS 305/25.5)
Sec.
25.5. Unlawful acts; penalties.
(a)
It is unlawful for any person, company, corporation, insurance
carrier, healthcare provider, or other entity to:
(1)
Intentionally present or cause to be presented
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any
false or fraudulent claim for the payment of any
workers' compensation benefit.
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(2)
Intentionally make or cause to be made any false
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or
fraudulent material statement or material representation
for the purpose of obtaining or denying any workers'
compensation benefit.
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(3)
Intentionally make or cause to be made any false
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or
fraudulent statements with regard to entitlement
to workers' compensation benefits with the intent
to prevent an injured worker from making a legitimate
claim for any workers' compensation benefits.
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(4)
Intentionally prepare or provide an invalid,
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false,
or counterfeit certificate of insurance as proof
of workers' compensation insurance.
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(5)
Intentionally make or cause to be made any false
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or
fraudulent material statement or material representation
for the purpose of obtaining workers' compensation
insurance at less than the proper rate for that insurance.
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(6)
Intentionally make or cause to be made any false
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or
fraudulent material statement or material representation
on an initial or renewal self-insurance application
or accompanying financial statement for the purpose
of obtaining self-insurance status or reducing
the amount of security that may be required to be
furnished pursuant to Section 4 of this Act.
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(7)
Intentionally make or cause to be made any false
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or
fraudulent material statement to the Division of
Insurance's fraud and insurance non-compliance
unit in the course of an investigation of fraud or
insurance non-compliance.
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(8)
Intentionally assist, abet, solicit, or conspire
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with
any person, company, or other entity to commit any
of the acts in paragraph (1), (2), (3), (4), (5),
(6), or (7) of this subsection (a).
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For
the purposes of paragraphs (2), (3), (5), (6), and
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(7),
the term "statement" includes any writing,
notice, proof of injury, bill for services, hospital
or doctor records and reports, or X-ray and
test results.
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(b)
Any person violating subsection (a) is guilty of a Class
4 felony. Any person or entity convicted of any violation
of this Section shall be ordered to pay complete restitution
to any person or entity so defrauded in addition to any fine
or sentence imposed as a result of the conviction.
(c)
The Division of Insurance of the Department of
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Financial
and Professional Regulation shall establish a fraud
and insurance non-compliance unit responsible
for investigating incidences of fraud and insurance
non-compliance pursuant to this Section. The
size of the staff of the unit shall be subject to
appropriation by the General Assembly. It shall be
the duty of the fraud and insurance non-compliance
unit to determine the identity of insurance carriers,
employers, employees, or other persons or entities
who have violated the fraud and insurance non-compliance
provisions of this Section. The fraud and insurance
non-compliance unit shall report violations
of the fraud and insurance non-compliance provisions
of this Section to the Attorney General or to the
State's Attorney of the county in which the offense
allegedly occurred, either of whom has the authority
to prosecute violations under this Section.
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With
respect to the subject of any investigation being conducted,
the fraud and insurance non-compliance unit shall have
the general power of subpoena of the Division of Insurance.
(d)
Any person may report allegations of insurance non-compliance
and fraud pursuant to this Section to the Division of Insurance's
fraud and insurance non-compliance unit whose duty it shall
be to investigate the report. The unit shall notify the Commission
of reports of insurance non-compliance. Any person reporting
an allegation of insurance non-compliance or fraud against
either an employee or employer under this Section must identify himself.
Except as provided in this subsection and in subsection (e), all
reports shall remain confidential except to refer an investigation
to the Attorney General or State's Attorney for prosecution or if
the fraud and insurance non-compliance unit's investigation
reveals that the conduct reported may be in violation of other laws
or regulations of the State of Illinois, the unit may report such
conduct to the appropriate governmental agency charged with administering
such laws and regulations. Any person who intentionally makes a false
report under this Section to the fraud and insurance non-compliance
unit is guilty of a Class A misdemeanor.
(e)
In order for the fraud and insurance non-compliance unit to
investigate a report of fraud by an employee, (i) the employee must
have filed with the Commission an Application for Adjustment of Claim
and the employee must have either received or attempted to receive
benefits under this Act that are related to the reported fraud or
(ii) the employee must have made a written demand for the payment
of benefits that are related to the reported fraud. Upon receipt
of a report of fraud, the employee or employer shall receive immediate
notice of the reported conduct, including the verified name and address
of the complainant if that complainant is connected to the case and
the nature of the reported conduct. The fraud and insurance non-compliance
unit shall resolve all reports of fraud against employees or employers
within 120 days of receipt of the report. There shall be no immunity,
under this Act or otherwise, for any person who files a false report
or who files a report without good and just cause. Confidentiality
of medical information shall be strictly maintained. Investigations
that are not referred for prosecution shall be immediately expunged
and shall not be disclosed except that the employee or employer who
was the subject of the report and the person making the report shall
be notified that the investigation is being closed, at which time
the name of any complainant not connected to the case shall be disclosed
to the employee or the employer. It is unlawful for any employer,
insurance carrier, or service adjustment company to file or threaten
to file a report of fraud against an employee because of the exercise
by the employee of the rights and remedies granted to the employee
by this Act.
For
purposes of this subsection (e), "employer" means any employer,
insurance carrier, third party administrator, self-insured,
or similar entity.
For
purposes of this subsection (e), "complainant" refers to
the person contacting the fraud and insurance non-compliance
unit to initiate the complaint.
(f)
Any person convicted of fraud related to workers' compensation pursuant
to this Section shall be subject to the penalties prescribed in the
Criminal Code of 1961 and shall be ineligible to receive or retain
any compensation, disability, or medical benefits as defined in this
Act if the compensation, disability, or medical benefits were owed
or received as a result of fraud for which the recipient of the compensation,
disability, or medical benefit was convicted. This subsection applies
to accidental injuries or diseases that occur on or after the effective
date of this amendatory Act of the 94th General Assembly.
(g)
Civil liability. Any person convicted of fraud who knowingly obtains,
attempts to obtain, or causes to be obtained any benefits under this
Act by the making of a false claim or who knowingly misrepresents
any material fact shall be civilly liable to the payor of benefits
or the insurer or the payor's or insurer's subrogee or assignee in
an amount equal to 3 times the value of the benefits or insurance
coverage wrongfully obtained or twice the value of the benefits or
insurance coverage attempted to be obtained, plus reasonable attorney's
fees and expenses incurred by the payor or the payor's subrogee or
assignee who successfully brings a claim under this subsection. This
subsection applies to accidental injuries or diseases that occur
on or after the effective date of this amendatory Act of the 94th
General Assembly.
(h)
All proceedings under this Section shall be reported by the fraud
and insurance non-compliance unit on an annual basis to the
Workers' Compensation Advisory Board.
(Source: P.A.
94-277, eff. 7-20-05.)
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