Illinois General Assembly Passes HB5228 – Significant Changes to the Illinois Workers’ Compensation Act

By Kisa P. Sthankiya

On May 31, 2026, the Illinois General Assembly passed HB5228. The bill amends several provisions of the Illinois Workers’ Compensation Act. The most notable changes are the amendments to Sections 12 and 8.7. Governor JB Pritzker has 60 days to approve, sign, or veto the bill. At this time, it appears unlikely that the bill will be vetoed.

Notably, the legislation faced significant opposition from employer and business interests during the legislative process. Numerous employer organizations, trade associations, and industry groups raised concerns regarding the impact of the proposed changes.

I. Amendment to Section 12 of the Illinois Workers’ Compensation Act

  • If an employer chooses to obtain an independent medical examination/opinion regarding the necessity of treatment instead of utilizing the utilization review process, the reviewing medical practitioner must issue the examination report within 90 days.
  • The 90-day period begins when the employer receives the medical records from the treating provider requesting the treatment.
  • The employer must exercise due diligence in obtaining those records from the treating provider.
  • The reviewing practitioner must be board certified in the same specialty as the employee’s treating health care professional.
    • For example, if the treating physician is an orthopedic surgeon, the reviewing physician must also be board certified in orthopedic surgery.
  • The examination report must be provided to:
    • the employee;
    • the employee’s representative (such as an attorney); and
    • the treating health care professional.

Consequences for Missing the 90-Day Deadline

If the employer fails to comply with these requirements after receiving the necessary medical records:

  • A rebuttable presumption arises that the employer is responsible for additional penalties and attorney’s fees  under Sections 16 and 19(l) of the Act.
  • A rebuttable presumption means the employer is presumed liable unless it can present some evidence to overcome that presumption.

What Conduct Is Covered?

The provision applies to:

  1. Failure to authorize or approve treatment; and
  2. Failure to pay for treatment.

II. Utilization Review – Section 8.7

The bill substantially revises utilization review requirements and significantly limits who may conduct reviews and issue adverse determinations.

  • Only licensed health care professionals may determine whether a medical service is medically necessary during utilization review.
  • If the treatment was recommended or provided by a physician, any denial or other adverse determination must be made by a physician.
  • The reviewing physician must:
    1. Hold a current, unrestricted medical license in the United States;
    2. Be board certified in the specialty relevant to the treatment being reviewed; and
    3. Have actual experience treating and managing patients with the same condition or disease involved in the request.
  • A licensed health care professional may deny a request from another provider only if the reviewer is licensed in the same profession as the provider who submitted the request.
  • For example, a treatment request submitted by an orthopedic surgeon must be reviewed by a physician who is board certified in orthopedic surgery.

III. Burial Benefit

The bill increases the statutory burial benefit from $8,000 to $10,000.

IV. Funding for the Illinois Workers’ Compensation Commission

The bill establishes a pro rata surcharge on insurance carriers to achieve an annual funding target for the Illinois Workers’ Compensation Commission.

V. State Licensure Compliance

The bill requires State-licensed entities to comply with Illinois workers’ compensation insurance requirements.

Employer Considerations and Recommended Next Steps

The amendments to Sections 12 and 8.7 represent some of the most significant changes to Illinois workers’ compensation claims administration in recent years and are likely to have a substantial impact on employers, carriers, third-party administrators, utilization review vendors, and independent medical examination providers.

Employers should begin evaluating their workers’ compensation programs now to ensure compliance with the new requirements if the bill becomes law.

Failure to comply with these provisions may increase exposure to penalties, adverse presumptions, and challenges to treatment denials.

We will continue to monitor HB5228 as it moves to the Governor for consideration and will provide updates regarding enactment, effective dates, and implementation issues. If you have questions regarding these amendments or their impact on your workers’ compensation program, please contact any attorney in our office. We would be pleased to discuss the practical implications of the legislation and assist with any questions or concerns.