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Illinois Comp Bill would help Employers/Insurers manage Claimants’ opioid usage

Illinois Legislative Update:

House Bill 5240 ( click here to read it) would amend the Workers’ Compensation Act by requiring a claimant who receives certain pain management medication to sign a written agreement with the prescribing physician agreeing to comply with the conditions of the prescription. Prohibits additional prescriptions while the recipient is non-compliant. Limits the applicability of the lack of pain management as a consideration in awarding benefits. Provides for the disclosure of violations of the agreement upon request by the employer. Requires a prescribing physician to file quarterly reports to obtain payment.


Here is the best part for Employers/Insurers:

“A payor who denies benefits in compliance with subsection (a-4.1) or subsection (a-5.3), performs utilization review as provided in Section 8.7, and finds the care to be inconsistent with national guidelines and protocols and that the prescriber failed to respond to the utilization review determination with a variance from the standards of care used in the utilization review that justifies the care is reasonably required and necessary to cure or relieve the effects of his or her injury, is rebuttably presumed to have acted in good faith and not subject to penalties under subsections (k) and (l) of Section 19.”

This would be an excellent modification to the Illinois Workers Comp Act, because so many claims today involve claimants who are addicted to pain meds. This would provide Employers with a way to tangibly determine if the claimant is non-compliant with the conditions for receiving opioid medication or to determine if the claimant’s treating physician is over-prescribing pain meds.

However, given the toxic political climate between the Illinois Legislature and Governor Rauner, the likelihood of this passing the Legislature and being signed into law is less than 50/50.

If you want to discuss this bill in greater detail, please let me know.