Under Illinois workers’ compensation law, the insurance company has a right to send you to a doctor of their choosing for a one time exam. Most of you know this is called an IME or independent medical examination.
What happens though if they want to send you to a second IME? There’s two ways to answer this, one that is pretty obvious I think and the other that until a recent phone call from an injured worker I had never seen happen. Let’s get the easy one out of the way first.
They can send you to a second IME if there’s been a change in your condition or they are trying to address a different issue. That usually involves a decent passage of time. Let’s say that the IME doctor is asked to see you to decide if you need a surgery and if so is it related to your job. He ends up not being a hired gun like many of those doctors and says that yes you do need the surgery and it’s because of your work accident. You end up with a lumbar fusion and six months later your doctor still has you off of work saying that you are not better. The insurance company could send you to a new IME to solely address whether or not you can return to work. They are asking the IME to talk about something new.
When you do go to an IME, it’s generally the case that the opinion of that doctor can be held against them. So if that doctor says something that goes against them, it’s too bad. In the same vein if your doctor finds against you, that opinion can be used against you.
This brings me to the crazy story.
The caller went to an IME to discuss whether or not he needed a surgery. The IME doctor said he did and it was due to the work injury. In 99.9% of cases I’ve ever seen, that would be that. He’d get the surgery and the case would move on. End of story.
In this case, the insurance company told the injured worker that they wanted a second opinion on their IME and sent him to a hired gun who said he’s fine. No surgery needed and he can return to work. That is, of course, ridiculous.
What’s crazier about this situation is that this caller had a lawyer. That attorney messed up big time because he should have told his client that he did not have to go to the IME as it was not addressing a new issue. I assume it’s a lawyer who dabbles in work comp and doesn’t know what they are doing or just doesn’t care.
The good news is that someone could take this case over and probably have the first IME be the deciding factor. The bad news is that by the time he got to me he’d waited over six months and is without income too. A crappy lawyer ruined his life and did not protect him.
So to answer the question, usually you have to go to a second IME, but not always.
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