Illinois HB 5228 Overhauls UR and IME Rules for Workers’ Comp Claims
- Illinois House Bill 5228, passed with veto-proof majorities, requires utilization review determinations to be made by a physician in the same or a comparable specialty as the treating provider, with relevant experience treating the condition at issue, giving claimants a new basis to challenge adverse decisions.
- The law limits UR certifications to three months, though a certified surgery automatically includes three months of post-operative care, which could broaden treatment authorization in some cases while discouraging treatment delays.
- When an employer uses an independent medical examination instead of UR to dispute treatment necessity, the IME physician’s specialty must be the same as the treating provider’s and complete the exam and report within 90 days of receiving the treatment request and records. Missing that deadline triggers a rebuttable presumption supporting penalties and attorney’s fees under the Workers’ Compensation Act.
- Applicants’ attorneys are already arguing the Section 12 changes apply retroactively to pending claims since they’re procedural rather than substantive, a position expected to generate significant litigation.
Bill Would Improve Access to Workers’ Comp for Federal Workers
- The Improving Access to Workers’ Compensation for Injured Federal Workers Act of 2025 (S. 3296), introduced by Sens. Susan Collins (R-Maine) and Richard Blumenthal (D-Conn.), would let federal employees receive treatment for work-related injuries or illnesses from state-licensed nurse practitioners and physician associates or assistants, rather than requiring a physician.
- Currently, federal employees can already choose an NP or PA as their primary care provider under the Federal Employees Health Benefits Program, but the Federal Employees Compensation Act requires a physician specifically to diagnose the injury, certify the disability, and oversee treatment for on-the-job injuries.
- Collins said the bill would help workers in rural areas, like her home state of Maine, avoid long travel and reduce wait times by allowing NPs and PAs to fill gaps in local access to care.
- The Senate bill is scheduled for a vote this week in the Senate Homeland Security and Governmental Affairs Committee, while a companion House bill (H.R. 3147), introduced by Reps. Tim Walberg (R-Mich.) and Joe Courtney (D-Conn.) in May 2025, currently has 16 cosponsors.