One common dispute in Illinois workers’ compensation cases is when your treating doctor, who knows you well and truly understands your injury says you need more treatment. The insurance company doesn’t want to spend any more money on your case so they send you to an IME doctor (doctor that they choose for a one time visit) that looks at you for three minutes and says you are fine.
The phrase you will hear at this point is that you are at MMI or maximum medical improvement. In plain English it means that the doctor says you are good as you are going to get.
Being at MMI should be your goal. Every client I’ve ever had wants to be healthy and back to work. Just because it’s your goal doesn’t mean that the IME doctor saying you are at MMI is true.
In fact, we’ve seen countless cases where the treating doctor says a worker needs surgery and the IME doctor says not only is a surgery not needed, the worker is totally fine. As you can imagine, often these IME docs are hired guns who make a ton of money off performing these exams. They get more business by telling the insurance company what they want to hear.
There was a case with this exact situation that recently went to trial at the Illinois Workers’ Compensation Commission. So how does the Judge decide who’s telling the truth?
A lot of it comes down to how prepared your lawyer is and if they ask the right questions and present all the relevant evidence. In the recent case, the lawyer for the injured worker did a good job for his client. The IME doctor said the worker was fine even though they were recovering from two surgeries. The treating surgeon said that further treatment was needed.
The medical records and testimony of the worker showed that she had ongoing symptoms and need for treatment. That is essentially the opposite of being MMI unless you don’t think the condition can get better. For that to be true it means the condition is stabilized. The credible testimony of the worker and doctor showed that she wasn’t at MMI.
Big picture for you is that you shouldn’t be surprised if an IME doctor says a bunch of nonsense. You just need to be prepared. Have a lawyer in your corner who knows their stuff, shows you through their customer service that they care about you and can demonstrate a track record of taking cases to trial. You don’t want to go trial if you don’t have to, but you need that option in case it comes down to that.