I’ve written before about the Illinois work comp law principle that says the insurance company can’t make you have surgery if you don’t want to.  Having something like a spine surgery is a big decision and it’s your decision.  If not having the surgery leaves you with permanent restrictions and costs the insurance company more money, that’s their problem.

I recently had a caller though with a different question.  He needed shoulder surgery per his doctor and as is their right, the insurance company sent him for an IME.  That doctor agreed that he needed a surgery and that it was work related. The case should be simple from there, right?

In this case it wasn’t.  The adjuster said she’d authorize the surgery, but only if the IME doctor could perform it. The caller was furious of course because he liked his doctor, only saw the IME for five minutes and really wants the surgery.

First things first, this is not how Illinois work comp law works.  They can’t make you have surgery and they can’t choose your surgeon.  It’s a simple problem for a lawyer to solve.

In the bigger picture you have to ask why is this happening at all. There are a couple reasons.

1. Often times insurance companies will see what they can get away with.  If this worker pushes back it’s cost them nothing.  If he doesn’t push back it’s a sign they can take advantage of him on other areas of the case including a settlement.  It’s possible they’ve already pushed him around on other issues.

2. My educated guess is that the adjuster wanted to do this because they could get the IME doctor to do the surgery for a cheaper amount.  Now more expensive doesn’t mean better, but I sure wouldn’t want the guy responsible for fixing my arm get the job only because he had the lowest bid. It wouldn’t surprise me if they send so much business to this doctor that they can kind of push him around on the price.

3. If you make the IME doctor the surgeon then they are no longer working on behalf of the company in theory.  That means the potential for the insurance company to get another IME exists.

4. The insurance company might know that the IME doctor rushes people back to work which will save them a few bucks.

Bottom line is that you have to look out for you and letting some random do your surgery, even if the insurance adjuster thinks they are great, is probably not a good idea.  But however you feel about it, it’s your call, not theirs.  They are interested mostly in money and not your health.

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