Illinois Approves Preferred Provider Program Administrators

In January of 2012, the Illinois Department of Insurance announced the first round of companies that have been approved as Preferred Provider Program (PPP) administrators under the recently enacted Illinois Workers' Compensation Act.

How Preferred Provider Programs (PPPs) Work

An employer is obligated to pay for the medical treatment costs of workers who experience illness or injury on the job. Preferred Provider Programs refer to health care providers an employer has approved to treat its injured workers. Employers may then hire approved administrators for PPPs that must be approved by the Illinois Department of Insurance.

If an employee reports an on-the-job injury to his or her employer, the employer must notify the injured worker if the company uses an approved PPP for Illinois workers' compensation claims. An injured worker in Illinois may select two medical providers. If an employer has an approved PPP, an employee may select two doctors from within that network.

If an employee wishes to "opt out" of the PPP network, he or she must notify the employer in writing. The "opt out" is then technically considered the employee's first choice, so he or she is then limited to only one choice of medical provider.

If an employer does not use a PPP, injured workers still have two choices for medical providers, just as they did under the previous Illinois workers' compensation regulations.

Recent Approval of Preferred Provider Programs

In early January 2012, the Illinois Department of Insurance announced its approval of the first three PPP administrators. The companies were HFN Inc., CorVel Healthcare and Coventry Health Care. For an updated list of approved administrators visit the Illinois Department of Insurance website. Employers who wish to use PPP administrators must select from those on this list.

Potential Problems of Preferred Provider Programs

PPPs essentially limit and control an injured worker's choice of doctor. Employers will likely select medical providers that line up with their interests. Therefore, there is a risk that companies may choose PPPs they feel will minimize costs by offering more minimal treatment and by urging injured employees to return to work before they are truly ready. In sum, PPPs may offer employers some cost savings while risking harm to injured workers.

Consult an Illinois Workers' Compensation Attorney

If you have suffered a work-related illness or injury, the advice of an experienced Illinois workers' compensation attorney can be very valuable. Especially since PPPs are new to Illinois, a knowledge lawyer can help guide you through the process and advise you of your rights.