Illinois General Assembly Passes HB5228: Big Changes to IMEs & Utilization Review

On 5/31/26, the Illinois General Assembly passed HB5228, amending several provisions of the Illinois Workers’ Compensation Act. Governor Pritzker has 60 days to approve, sign or veto the bill.

Independent Medical Examinations

• If an IME opined on the reasonableness and necessity of treatment instead of utilizing the UR process, the IME must issue report to Petitioner, Petitioner’s counsel and treater within 90 days
• 90-day period starts when employer receives medical records from doctor requesting treatment
• Employer must exercise due diligence in obtaining those records from the treating provider
• IME must be board certified in the same specialty as treater
• If 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 Section 16 and 19(l) of the Act
• This provision applies to failure to authorize or approve treatment; and failure to pay for medical treatment

Utilization Reviews

• UR doctor must be licensed health care professional
• The reviewing doctor must have the same medical license as the treater, be board certified in the relevant specialty and have actual experience in treating patients with the same condition

Burial Benefit

• Increases statutory burial benefit from $8,000.00 to $10,000.00

Take-Aways

• Utilization Review is still your first line of defense
• A positive UR creates a rebuttable presumption in our favor that treatment is not reasonable or necessary
• If getting an IME to challenge treatment, act quickly
  • Schedule the IME with enough time so the report is issued within 90 days
  • Get the relevant medical records early to send to your reviewing physician
  • If you suspect prior treatment, conduct medical canvass and issue subpoenas immediately
• IME still effective to challenge causation
• Always use board-certified physician currently licensed to practice in the US
• Always hire specialist who treats/manages same conditions as Petitioner