Illinois Administrative Code

Section 2902.40 Rule Manual Filings a) Manual filing requirements can be met either by a company making a direct filing on its own behalf or a company authorizing a rating organization of which it is a member or subscriber to make the filing on the company's behalf. 1) A company …

Section 2902.50 Rate Filings a) Rate filing requirements can be met by: 1) A company making a direct filing on its own behalf; 2) A company filing to adopt its rating organization advisory rate filing; 3) A company filing a deviation to its rating organization advisory rate filin…

Section 2902.60 Exemption From Filings (Repealed) (Source: Repealed at 46 Ill. Reg. 6583, effective April 11, 2022)

Section 2902.70 Submission of Filings a) All manual and rate filings required by this Part must be received no later than 30 days before the effective date of use. b) All manual filings made by a rating organization to which it will require adherence of its members and subscriber…

Section 2902.ILLUSTRATION A Summary Sheet (Repealed) (Source: Repealed at 38 Ill. Reg. 21484, effective October 31, 2014)

Section 2903.10 Authority This Part is promulgated by the Director of Insurance under Section 401 of the Illinois Insurance Code (Ill. Rev. Stat. 1985, ch. 73, par. 1013), which empowers the Director to make reasonable rules and regulations as may be necessary for making effectiv…

Section 2903.20 Purpose and Scope The purpose of this Part is to implement Section 466 of the Illinois Insurance Code by requiring the recording and reporting of premium, loss and expense experience for companies that write workers' compensation and employers' liability insurance…

Section 2903.30 Statistical Agent The Director of Insurance shall designate a statistical agent to assist in the recording and reporting of premium, loss and expense experience for workers' compensation and employers' liability insurance required pursuant to this Part. The design…

Section 2903.40 Reporting Every insurer who is a member or subscriber of the designated statistical agent shall record and report its premium, loss and expense experience to the agent in accordance with the statistical reporting plan developed by the agent and approved by the Dir…

Section 2903.50 Statistical Plan The statistical reporting plan approved by the Director of Insurance shall be maintained by the Director of Insurance and made available for public inspection. In addition, a copy of this plan shall be filed with the State Library of the Secretary…

Section 2904.10 Statutory Authority This Part is promulgated by the Director of Insurance pursuant to Sections 401 and 466 of the Illinois Insurance Code (Code) [215 ILCS 5/401 and 466]. (Source: Amended at 38 Ill. Reg. 15611, effective July 2, 2014)

Section 2904.100 Installment Payment of Premium Policies with an estimated premium of $1,000 or less shall be paid in full. Payment of the estimated annual premium is required in accordance with the filed and approved Plan. An installment payment plan may be requested by the empl…

Section 2904.110 Insurance Policy to be Issued by Assigned Carrier Within Ten Days After Receipt of Payment A policy or binder shall be issued to the eligible employer and producer within 10 days after receipt of the required premium payment. (Source: Amended at 38 Ill. Reg. 1561…

Section 2904.120 Final Earned Premium Final earned premium for any policy issued under the requirements of this Part shall be determined on actual, instead of estimated, payroll or other premium basis.

Section 2904.130 Renewal of Policies Issued Under this Part a) The assigned carrier shall, 60 days prior to the expiration of the policy, submit to the employer and producer a notice of premium for renewal of the policy. If the renewal premium is not received by the assigned carr…

Section 2904.140 Policy Termination – General The assigned carrier may terminate a policy issued under this Part as permitted by law. The termination notice shall indicate whether the policy is being cancelled or nonrenewed. The termination notice shall include the proposed date …

Section 2904.150 Policy Termination for Failure to Comply With Employee Welfare Laws Termination for failure to comply with Employee Welfare Laws shall be based upon a finding of violation by the appropriate Federal, State or local enforcement authority. The termination request s…

Section 2904.160 Policy Termination – Hearing a) An employer who wishes to object to the reason or reasons for termination shall, within 10 days after receipt of the notice of termination, mail or deliver to the Director of Insurance a written request for a hearing that shall cle…

Section 2904.170 Policies of Insurance and Termination Notice to be Imprinted "Assigned Risk" All assigned carriers shall stamp or print on all policies or binders of Insurance or Termination Notices filed pursuant to this Part the words "Assigned Risk" in letters not less than ⅜…

Section 2904.180 Annual Reports Required of Mutual and Stock Insurance Pools The Mutual and Stock Pools shall each file with the Department of Insurance, not later than March 1st of each year, a report showing for the previous calendar year: a) The total combined compensation pre…

Section 2904.190 Rating Standards All assigned carriers shall rate all policies issued under this Part in accord with the Manuals of Rules and Rates filed with the the Administrator and approved by the Department of Insurance. The Administrator shall establish audit procedures an…

Section 2904.20 Purpose and Scope It is the purpose of this Part to provide the requirements and procedures for participation in the Illinois Assigned Risk Plan for Workers' Compensation Act [820 ILCS 305] and Workers' Occupational Diseases Act [820 ILCS 310] Coverage. This Part …

Section 2904.200 Location of Servicing Office and Records All assigned carriers shall have their records readily available. All assigned carriers shall include with the premium notice the name and telephone number of the person to contact concerning the policy.

Section 2904.210 Cost Containment All assigned carriers shall adopt measures to contain costs in the distribution of benefits in accordance with standards, orders or directives prescribed by the Director.

Section 2904.220 Procedure to be Followed in the Suspension of Insurance Carriers for Non-Compliance with this Part If any carrier refuses or neglects to comply with any of the provisions of this Part, the Director shall pursue the suspension of the Certificate of Authority of th…

Section 2904.230 Penalties Any carrier or producer failing to comply with the requirements of this Part shall be subject to penalties as may be appropriate under the Code. (Source: Amended at 38 Ill. Reg. 15611, effective July 2, 2014)

Section 2904.240 Severability If any provision of this Part shall be held invalid, the remainder of the Part shall not be affected thereby.

Section 2904.30 Written Acceptance Required of All Insurance Carriers Writing Workers' Compensation and Occupational Diseases Insurance in Illinois Every carrier writing Workers' Compensation and Workers' Occupational Diseases insurance in the State of Illinois shall file with th…

Section 2904.40 Definitions As used in this Part, the following terms have the definitions set forth: "Act" means the Workers' Compensation Act [820 ILCS 305] and Workers' Occupational Diseases Act [820 ILCS 310]. "Administrator " means a qualified entity who administers the mana…

Section 2904.50 Designee For the purpose of assisting in the assignment of an employer to a carrier, the Administrator is appointed the designee of the Department of Insurance pursuant to Sections 401 and 468 of the Illinois Insurance Code [215 ILCS 5/401 and 468]. (Source: Amend…

Section 2904.60 Procedure for the Assignment of an Employer An eligible employer seeking Assigned Risk Insurance will be bound under the Illinois Assigned Risk Plan in accordance with the following procedures: a) Within 60 days prior to application the employer must have requeste…

Section 2904.70 Procedure for Immediate Binding of Coverage An employer seeking Assigned Risk Insurance may be bound under the Illinois Assigned Risk Plan in accordance with the following procedures. a) Within 60 days prior to application the employer must have requested and been…

Section 2904.80 Premium Notice to be Filed with the Bureau (Repealed) (Source: Repealed at 38 Ill. Reg. 15611, effective July 2, 2014)

Section 2904.90 Commissions Any casualty producer who is licensed to place insurance through the facilities offered herein, shall be entitled to a commission at a rate determined by the Department of Insurance. Commissions shall be paid as follows: a) When the payment of premium …

Section 2905.10 Definitions "Act" means the Workers' Compensation Act [820 ILCS 305]. "Department" means the Illinois Department of Insurance. "Director" means the Director of the Illinois Department of Insurance. "Utilization Review" means the evaluation of proposed or provided …

Section 2905.20 Registration a) On or after July 1, 2005, a workers' compensation utilization review organization may not conduct utilization review for workers' compensation services as provided by Section 8.7 of the Act unless the utilization review organization has registered …

Section 2905.30 Fees A workers' compensation utilization review organization must register with the Director every two years. A fee of $3,000 must be submitted with each application or renewal unless the utilization review organization is accredited under the Health Utilization M…

Section 2905.40 Material Changes Any material changes in the information filed pursuant to this Part shall be filed with the Director within 30 days after the change. Loss of accreditation status will require re-registration and payment of a $3000 fee pursuant to Sections 2905.20…

Section 2905.50 Renewals and Appeals a) If a renewal application and fee are not received prior to the renewal date, the registration will automatically expire and the utilization review organization must re-register and pay a fee pursuant to Sections 2905.20 and 2905.30 of this …

Section 2905.EXHIBIT B Utilization Review Organization Officers and Directors Biographical Affidavit (Repealed) (Source: Repealed at 46 Ill. Reg. 9867, effective May 31, 2022)

Section 2907.10 Purpose and Scope a) The purpose of this Part is to establish content, form and data reporting requirements for information required to be reported to the Director by Section 29.2(b) of the Workers' Compensation Act [820 ILCS 305]. This Part also establishes the m…

Section 2907.20 Definitions "Code" means the Illinois Insurance Code [215 ILCS 5]. "Department" means the Illinois Department of Insurance. "Director" means the Director of the Illinois Department of Insurance. (Source: Amended at 43 Ill. Reg. 3285, effective February 25, 2019)

Section 2907.30 Reporting Requirement a) Scope of Procedure Each insurer licensed to write workers' compensation coverage in the State shall report to the Department information on an aggregate basis before March 1 of each year, relating to claims in the State opened within the p…

Section 2907.40 Coding Conventions for the Insurance Oversight Workers' Compensation Data Collection The data described in Section 2907.30 must be submitted to the Department electronically in a Comma Separated Values (.csv) format. A sample table illustrating the format of the d…

Section 2907.APPENDIX A Data Element Definitions Field # Data Field Data Definition Date Based On: 1 Company NAIC # Character value 5 digits "00000" 2 Company FEIN Character value 10 digits "00-0000000" 3 Company Name Character value any length 4a Company Contact Name Character v…

Section 2908.10 Applicability Every employer and insurer, or the employer's or insurer's payer or payer's agent, and every third party administrator must accept electronic claims for payment of medical services as provided by Section 8.2a of the Act. Every health care provider or…

Section 2908.100 Administrative Fines a) The Department shall impose an administrative fine if it determines that a payer has failed to comply with the electronic claims acceptance and response process required by this Part or by the Act. The amount of the administrative fine sha…

Section 2908.20 Purpose and Scope Subject to Section 8.2a of the Act, the purpose of this Part is to set forth the requirements for electronic billing, processing and payment of medical and facility services, treatments and products and to adopt standardized forms provided to an …

Section 2908.30 Definitions "Act" means the Workers' Compensation Act [820 ILCS 305]. "ASC X12 Standards for Electronic Data Interchange" means Accredited Standards Committee X12 (ASC X12) EDI American National Standards, with reports incorporated by reference in this Part publis…

Section 2908.40 Formats for Electronic Medical Bill Processing a) For electronic transactions, the following electronic medical bill processing standards shall be used: 1) Billing: A) Professional Billing – The ASC X12 Standards for Electronic Data Interchange Technical Report Ty…