A recent caller had a scenario that we hear a lot. He is alleging that he has carpal tunnel and possibly cubital tunnel (elbow) injuries from typing all day for over five years at his current job. His doctor thinks that’s what it is and has ordered a nerve conduction study called an EMG. That test is the gold standard for diagnosing carpal tunnel. Here’s where the problem comes in.
He wants the EMG, but the provider the insurance company wants him to go to for that can’t see him for over three months. So in their world, the case is not approved because the EMG hasn’t taken place yet. And when it does, they then want him to see a doctor of their own choosing for an IME.
So he asked my opinion as to how long it should take until benefits are approved.
The answer is that they should be approved until there is evidence that they shouldn’t be. If his doctor says he has these injuries and they are work related, that should be enough. They have a right to an IME, but they don’t have right to delay this case until they get one.
And even with the EMG, there is no way that test should take over three months to happen. He should see a provider of his own choosing to make it happen. That can usually happen in a week or two.
The problem is that he hasn’t formally filed his case by hiring an attorney and filing an Application For Adjustment of Claim with the Illinois Workers’ Compensation Commission. Because that hasn’t happened yet, he lacks the ability to push back on their unreasonable delay.
The good news is that most work comp lawyers would know a reputable EMG facility he could go to and quick. Beyond that, if the IME was in a week or two that would be one thing, but expecting him to wait many months is unreasonable. And that is generally the standard for what they can or can not get away with. Are their actions reasonable? Here they clearly are not.
My advice to any injured Illinois worker is that you don’t let the insurance company dictate how long things should take or who your doctor should be. You have to look out for your own best interests. I guarantee you that the insurance company is not thinking about what is best for you.
The good news is that it costs nothing to hire a lawyer and file a case. And usually in these nonsense situations, a phone call and/or a trial motion can solve most problems.
In general though, once the insurance company is given medical evidence as well as can confirm how the accident took place, anything longer than two weeks to approve benefits to me is an unreasonable delay. The only exception is when they have a legitimate reason to dispute your claim such as conflicting witnesses, medical records that say you weren’t hurt at work, etc.
If you’d like help with a case or just have questions, please call us any time at 312-346-5578. We cover all of Illinois