Under Illinois workers’ compensation law, while you generally have a right to choose your own doctor, your employer, through their insurance company, has a right to send you to a doctor of their choosing as well.
The difference is that while your doctor would be considered a treating doctor, their doctor is only meant to see you once. They are not your doctor, but instead owe an allegiance to the people paying their bill. These exams are ironically called independent medical examinations or IME’s.
The purpose of an IME is for a doctor to look at you and your medical records and then answer questions that the insurance company has. These questions often include:
- What is the injury?
- Is the injury related to the job or something else?
- Does the worker need to be off work?
- Can they work with restrictions?
- What treatment is needed?
- Is a surgery reasonable?
- Is the need for treatment related to a work injury or something else?
Often these doctors are hired guns. Injured Illinois workers that we talk to are shocked when an “exam” lasts 3-5 minutes. The truth is that a lot of these doctors make a huge living just off these reports and want to keep the cash cow going. If they see 10-15 of these patients a week along with doing depositions on some of these cases, it’s not unheard of for them to make over $1 million a year from this part of their business alone.
The most common question we get from injured workers is what happens next after an IME?
The answer is it depends on why the IME happened and the results.
Most IME reports seem to be against the injured worker. If that happens you can expect that the report will be prepared and provided rather quickly and you will receive notice that your benefits have been suspended or the case has been denied.
When that happens, the only next step is to have your lawyer file what is called a 19(b) petition for immediate hearing. This is a legal process at the Illinois Workers’ Compensation Commission to get your case before an Arbitrator ASAP. Your case probably can’t go to trial right away, but it gives your lawyer a chance to discuss the case with the other attorney. This is also why it’s important to have a lawyer in place so they can be prepared with these filings.
Before your case can go to trial, your lawyer will likely have to take the deposition of your doctor and the IME doctor. These are called evidence depositions. That means that instead of showing up to court, their testimony takes place by deposition and the Arbitrator will read them after the trial.
The entire process from getting the IME denial letter until going to trial can be 3-6 months depending on how aggressive your lawyer is.
But what happens if I went to an IME months ago and haven’t heard anything yet?
This result happens all of the time. There is no law that requires the IME doctor to prepare a report or for the insurance company to turn it over. Like I said, when it is in their favor it is usually produced right away.
When they do not provide one, it is a sign that the IME doctor will not say what they want them to say. In those cases a few things can happen:
- They might just call the adjuster to deliver the bad news, but not put their findings in writing. That way you can not submit a report that hurts them.
- They might provide the report to the adjuster, but that person will just stick their head and the sand and lie about its availability.
So how do you solve this problem, especially if they continue to delay your benefits?
There are two solutions. The first is that your lawyer again should file a 19(b) petition. When an IME takes place and is not produced, Illinois law assumes that it would not be favorable for the insurance company. So while it is not as strong as having the actual document, it really works in your favor. Your attorney can at the very least pressure the other side to pay you and approve treatment until the IME is available, especially if it’s been over a month.
The second option is your lawyer can subpoena the IME doctor for a copy of the report. Different attorneys disagree as to whether or not you can get it by subpoena, but most doctors do not want to be bothered and often will comply. Or at the very least this will cause the insurance company to show their cards and give it to you.
All of this demonstrates why having an aggressive Illinois workers’ compensation lawyer is so important. Nobody should be waiting more than a month for a report without any action being taken. The insurance company has a goal to frustrate you into using your own insurance or ignoring your doctor’s advice. Don’t let them beat you down.
If you were hurt on the job in Illinois and would like a free case review, please call us any time at 312-346-5320. We help injured workers everywhere in Illinois.
