A nice woman called us as she was the victim of a bogus work comp denial. She had cut herself badly at work and while the insurance company initially accepted her claim, they did send her for an independent medical examination (“IME”).
The facility she was sent to is huge because there are tons of doctors and medical services provided there. It’s also a facility which does a lot of these IME’s because they are great money makers for the doctors. The insurance company didn’t give specific directions of where to go once she got to the facility and the injured worker ended up lost. She eventually found the right location, but was 30 minutes late so they told her she had missed her appointment and could not have the IME that day.
The woman asked to set a new time and they said no, that has to be done through the insurance company. These “exams” typically last just five minutes or so, so when one person is late it throws off their whole schedule and ability to see a bunch of injured workers in a short period of time. They make hundreds for these quick exams and in an hour a doctor can make thousands of dollars for very little work.
The injured worker called the insurance company to try and get a new exam date and they told her that since she didn’t go to the IME they were cutting off her benefits. She offered to go to a new exam and they refused to schedule one because they got charged for the first one.
You have to go to an IME if the insurance company schedules one. If you refuse to go they can cut off your benefits until a new exam takes place. No matter how ridiculous their request for an IME seems and even if you know the doctor they are sending to you is a hack of a hired gun, you have to go. It’s stupid, but it’s the system we have.
In this case though, the injured worker clearly did not try to miss the IME. Yes she was late, but not willfully. It’s no different than if her car broke down on the way to the exam or if bad weather shut down some roads.
The real problem is that this office sees IME patients one day a week for a short window of time. Their business isn’t finding out what really is wrong with this person’s hand, but instead it’s seeing as many people as possible in as short of a time as possible. Since they get to charge the insurance company either way, they had no incentive to let this woman even wait for the last exam of the day. They literally wouldn’t spare five minutes for her.
So to me the denial of her benefits is complete crap and it only happened because she did not have a lawyer at the time. We’ve been involved in many other cases where there was an accidental failure to be at an IME on time for a variety of reasons and in those cases benefits were not suspended.
So now trial motions and penalty petitions have to be filed although this should get resolved with a phone call.
My advice for you as an injured worker is that if you do have an IME, you have to go and should talk to a lawyer ahead of time about what to expect. It can be disappointing to get there and realize that you are a part of a medical cattle call and the doctor examining you is hoping to get on to other things. Talking about what to say and what might happen (some of these facilities do surveillance on you as you walk to and from the parking lot for example) is important in protecting your Illinois workers’ compensation rights.
