A worker who had been recovering from an injury contacted us, wanting to know whose doctor has the final say about returning to work full time. His doctor said he was authorized off of work and needed more treatment. The insurance company IME doctor said he was fine and could return to work with no more treatment.
In short, neither physician is able to make a final, definitive ruling regarding the state of your injury. The arbitrator hearing your case has that ultimate responsibility. However the arbitrator, in order to make a properly-informed and reasoned decision, will weigh the findings and opinions of the physicians’ records, and also the credibility of the physicians themselves.
The reputations of the doctors will likely come into play in evaluating the credibility of their findings. Some doctors are known for routinely denying causation or injury. Others enjoy better reputations, and therefore are more likely to have the arbitrator defer to their judgment. More information regarding the specifics of each of the doctors involved is needed, therefore, to be able to answer the question as to which will be more relied upon by the arbitrator. You would be surprised how many times someone calls us to complain about an IME doc and we are able to guess who it is based on what the doctor said. Plain and simple, many of these doctors are just hired guns who everyone knows will favor the insurance company.
There are some precautions you can take to better position yourself and your treating physician’s findings, such as care in physician selection. When your insurance company is choosing a doctor for a Section 12 Independent Medical Examination, this so-called “independent” physician is likely a specialist in the particular area of concern. The experience in the specialized medical area could be given more weight by the arbitrator, than your doctor’s experience if he or she is an internist or a primary care physician. For example, if you have a shoulder injury, you would be better served by being treated by a specialist, because I can virtually assure you that your insurance company hired an orthopedist to examine you.
If you have had a denial of medical care based upon a Section 12 examination report, you likely need to consult an attorney to help you overcome this problem regarding conflicting opinions of “experts.” The best thing an attorney can do is get your case ready for trial and show the Arbitrator that your physician is credible and there’s is not.
We are workers’ compensation attorneys that help people with Illinois work injuries anywhere in IL via our statewide network of attorneys. Contact us and we will answer your questions or find the right lawyer for your situation.