New Illinois Workers’ Comp Law: 90-Day IME Rule and Stronger Medical-Treatment Protections

By Matthew C. Jones, Illinois Workers’ Compensation Lawyer
Published August 13, 2026; last reviewed August 13, 2026.

Quick answer: Illinois changed its workers’ compensation law on August 7, 2026. Public Act 104-0792 creates a 90-day deadline for certain employer-requested medical examinations used to dispute whether treatment is reasonable and necessary. The examining doctor must be board-certified in the same specialty as the treating provider. The law also strengthens utilization-review requirements and creates a rebuttable presumption supporting Section 16 attorney’s fees and Section 19(l) penalties when an employer fails to comply with the new Section 12 requirements.

The law is important, but it does not mean every surgery is automatically approved after 90 days. It also does not apply in the same way to every IME or every defense. The exact reason the insurance company is denying treatment—medical necessity, causation, or something else—still matters.

At McHargue & Jones, we regularly handle Illinois workers’ compensation cases involving IME disputes, denied surgery, utilization review, stopped TTD checks, and Section 19(b) hearings. Here is what the new law changes and what injured workers should know.

Governor Signs HB 5228 as Illinois Public Act 104-0792

The Governor approved HB 5228 on August 7, 2026. It is now Public Act 104-0792, and it became effective the same day.

The new law changes several parts of the Illinois Workers’ Compensation Act. For most injured workers, the biggest changes involve:

• a 90-day deadline for certain Section 12 examinations and reports addressing whether medical care is reasonable and necessary;
• a same-specialty board-certification requirement for the doctor performing that examination;
• new potential Section 16 attorney’s fees and Section 19(l) penalties for noncompliance;
• stronger qualifications for utilization-review doctors;
• longer protection for treatment and surgery that utilization review has already certified; and
• an increase in the burial benefit from $8,000 to $10,000.

What Is the New 90-Day IME Rule?

Section 12 allows an employer or workers’ compensation insurance company to request a medical examination by a doctor it selects. This is commonly called an independent medical examination, or IME.

Under the new law, when the employer asks a medical practitioner to evaluate the reasonableness and necessity of proposed or already-provided medical services instead of using utilization review, both the examination and the report must be provided to:

• the injured worker or the worker’s representative; and
• the injured worker’s treating health care professional.

The 90-day period begins when the employer receives the medical records from the treating health care professional requesting the medical service. The law also requires the employer or its representative to use due diligence in requesting and collecting the records.

That makes documentation critical. When a treating surgeon recommends a procedure, the recommendation and supporting records should be transmitted in a way that proves exactly what was sent and when it was received.

The IME Doctor Must Be Board-Certified in the Same Specialty

For an examination covered by the new medical-necessity paragraph, the examining practitioner must be board-certified in the same specialty as the treating health care professional.

For example, if an orthopedic spine surgeon recommends a lumbar fusion and the insurance company uses a Section 12 examination instead of utilization review to dispute whether that surgery is necessary, the insurance company should not be able to rely on a doctor from an unrelated specialty for that determination.

This does not mean the treating doctor automatically wins. An Illinois Workers’ Compensation Commission arbitrator may still compare the medical opinions, records, diagnostic testing, examination findings, and testimony. Our guide to IME doctor versus treating doctor disputes explains how that evidence is evaluated.

What Happens if the Employer Misses the 90-Day Deadline?

If the employer fails to comply with the new paragraph after receiving the treating provider’s records requesting the service, the law creates a rebuttable presumption that the employer is responsible for additional compensation under Section 16 and Section 19(l).

The new paragraph expressly applies to:

• failure to authorize or approve treatment; and
• failure to pay for treatment.

Section 19(l) can allow additional compensation of $30 per day, up to $10,000, when benefits are withheld or refused without good and just cause. Section 16 can allow attorney’s fees and costs to be assessed against the employer or carrier in qualifying cases.

Important limitation: the new law does not say that treatment automatically becomes reasonable and necessary merely because the report is late. It also does not expressly say that a late report is automatically excluded from evidence. The missed deadline strengthens a claim for penalties and attorney’s fees, but the injured worker may still need to prove that the treatment is reasonable, necessary, and causally related to the work injury.

Does the 90-Day Rule Apply to Every IME?

No. The new paragraph is directed at a Section 12 examination used instead of utilization review to address the reasonableness and necessity of medical services.

It does not expressly create the same 90-day deadline for an IME opinion limited to:

• whether the accident happened;
• whether the condition is causally related to work;
• whether the worker can return to work;
• whether the worker has reached maximum medical improvement; or
• the nature or extent of disability.

That distinction may become a major issue. An IME doctor may say that surgery is not needed, which is a reasonableness-and-necessity opinion. Another doctor may accept that surgery is medically appropriate but claim it is needed because of degeneration or a prior condition rather than the work accident, which is primarily a causation opinion.

Mixed reports may create litigation over whether the new rule applies. The heading placed on the report should not be the only thing that matters; the actual opinions should be examined.

How Did Illinois Change Utilization Review?

Utilization review, often called UR, is a records-based process used to decide whether proposed or provided treatment meets medical-necessity standards. Insurers often use UR to deny surgery, therapy, injections, diagnostic testing, and other care.

Public Act 104-0792 strengthens the qualifications required for an adverse utilization-review decision. When the requested service is delivered or recommended by a physician, the adverse determination must be made by a physician. The reviewing physician must have:

• a current, unrestricted license in a United States jurisdiction;
• current certification by a recognized American medical specialty board in an area appropriate to the review; and
• experience treating and managing patients with the medical condition or disease involved.

A physician must also handle the appeal when a physician recommended or would provide the care. The appeal reviewer must have appropriate board certification—and, where applicable, subspecialty certification—plus experience treating and managing patients with the condition at issue.

The law contains an exception allowing a properly qualified licensed health care professional to review a service requested by a professional licensed in the same profession. That may matter when the request comes from a chiropractor, physical therapist, or another non-physician provider.

How Long Does a UR Approval Remain Valid?

A utilization-review certification now remains valid for the three months immediately after the employee and health care provider receive it or for the course of treatment determined by the employee’s health care provider.

If UR certifies a proposed surgery, that certification includes three months of postoperative health care that the treating professional considers clinically indicated or the provider-determined treatment period.

This change should reduce situations in which an insurer approves a procedure but then argues that the approval expired before the care could be completed, or separately refuses ordinary postoperative treatment that should accompany an approved surgery.

Can the Insurance Company Obtain Both UR and an IME?

The new Section 12 paragraph refers to an examination used “instead of” utilization review. The law does not clearly answer every situation in which an insurer obtains both.

We expect employers and carriers to use utilization review quickly after receiving an expensive treatment recommendation and, in some cases, also schedule an IME. A compliant UR report may create a legitimate medical dispute and may be considered with the rest of the evidence. It does not necessarily make a late or noncompliant IME disappear.

On the other hand, an insurer should not be able to avoid scrutiny merely by labeling one review “UR” while separately using an unqualified or untimely Section 12 doctor to dispute the same treatment. This is one of the issues the Commission and reviewing courts may need to decide.

What Should an Injured Worker Do After a Doctor Recommends Surgery or Other Care?

The new law makes a clear paper trail even more important. If your treating doctor recommends surgery, physical therapy, injections, testing, or another service:

1. Get the recommendation in writing. The record should identify the diagnosis, requested treatment, and medical reasons for it.
2. Make sure the supporting records are sent. The 90-day period is tied to the employer’s receipt of the treating provider’s records requesting the service.
3. Keep proof of receipt. An email, delivery receipt, fax confirmation, or other reliable evidence may later become a trial exhibit.
4. Ask for every UR and IME report. The doctor’s specialty, board certification, timing, records reviewed, and actual opinions may all matter.
5. Attend a properly requested IME. The new law does not eliminate the worker’s obligation to cooperate with a reasonable Section 12 examination. Missing or obstructing the exam can create serious problems and may suspend benefits.
6. Do not assume you must wait indefinitely. A denied-treatment case may be appropriate for a Section 19(b) hearing before the IWCC.

Read our detailed guide on what to do when workers’ comp denies surgery in Illinois.

Can an Illinois Workers’ Comp Judge Still Order Surgery?

Yes. When the evidence supports the injured worker, an IWCC arbitrator can order the employer or insurer to authorize reasonable, necessary, and causally related medical care.

These cases may require medical records, treating-doctor testimony, cross-examination of the IME or UR doctor, proof of when the treatment request was received, and testimony from the injured worker. Our Illinois workers’ comp hearing and trial guide explains that process.

We have won contested cases in which arbitrators ordered knee, back, neck, hip, hand, and other surgeries after the insurer refused care. See our Illinois workers’ compensation surgery trial wins and our case study explaining how we won denied neck surgery and TTD after an IME and defended the result on appeal.

Prior results do not guarantee a similar outcome. Every case depends on its facts, medical evidence, testimony, doctors, procedural history, and applicable law.

Does the New Law Apply to Workers Injured Before August 7, 2026?

Public Act 104-0792 took effect immediately on August 7, 2026. It does not contain language limiting every amendment to accidents occurring on or after that date. It also does not expressly resolve how each provision applies to requests, denials, or examinations that occurred before the law was signed.

That means application to pending claims may be disputed. There is a strong argument that current procedures should govern new treatment requests, new examinations, and new reports in active cases. Employers and insurers may argue that provisions increasing penalty or fee exposure cannot be applied to conduct completed before the effective date.

For an injured worker with an active case, the safest practical approach is to make sure any current treatment recommendation and supporting records are transmitted and documented now. A lawyer can evaluate whether the new deadline and presumptions apply to the specific facts.

Other Changes in Public Act 104-0792

The new law also:

• raises the workers’ compensation burial benefit from $8,000 to $10,000;
• strengthens enforcement against certain state-licensed businesses that fail to prove workers’ compensation coverage; and
• creates an additional insurance-company surcharge designed to provide a defined annual funding target for IWCC operations, beginning at $7 million for 2026 and increasing by 3.5% per year.

Those changes matter, but the IME, utilization-review, treatment-authorization, and penalty provisions will have the most direct effect on many disputed injury claims.

Frequently Asked Questions

Does Illinois workers’ comp now have 90 days to approve surgery?

Not exactly. The 90-day rule applies when the employer uses a Section 12 medical examination instead of utilization review to address whether proposed or provided treatment is reasonable and necessary. It requires the examination and report to be furnished within the statutory period. It is not a universal 90-day approval rule for every treatment dispute.

Is surgery automatically approved if the IME report is late?

No. The law creates a rebuttable presumption supporting Section 16 attorney’s fees and Section 19(l) penalties. It does not expressly make the treatment automatically reasonable and necessary or automatically exclude a late report.

Does the same-specialty rule apply to every workers’ comp IME?

The new same-specialty requirement applies to the Section 12 examination described in the new paragraph—an examination used to determine whether medical treatment is reasonable and necessary instead of utilization review. The statute does not expressly apply that requirement to an opinion limited to causation, MMI, work restrictions, or disability.

What qualifications does a utilization-review doctor need?

For physician-recommended or physician-delivered care, an adverse determination must be made by a physician with an unrestricted license, appropriate current board certification, and experience treating and managing patients with the condition involved. The appeal reviewer must meet similar requirements, including subspecialty certification where applicable.

Can workers’ comp still deny treatment because it claims the condition is not work-related?

Yes. The new 90-day paragraph addresses reasonableness and necessity, not every causation defense. An employer may still dispute whether the work accident caused or aggravated the condition. That defense must still be supported and can be challenged at the IWCC.

Do I still have to attend an IME?

Generally, yes, if the examination is properly requested and reasonable. Public Act 104-0792 adds deadlines and qualifications for certain treatment-necessity examinations; it does not eliminate the employee’s duty to cooperate with a proper Section 12 request.

This article provides general information about Illinois workers’ compensation law and is not legal advice. Reading it does not create an attorney-client relationship. The law is new, and some questions may require interpretation by the Illinois Workers’ Compensation Commission and reviewing courts. Every case depends on its own facts and applicable law.