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Often in workers’ compensation claims, things happen that don’t seem to make sense or seem like they might be against the law. Often that is true such as when the insurance company tries to have a nurse case manager attend your doctor’s appointments. That’s not allowed, but some of them act like bullies and will do this if you don’t stand up for yourself.
Other times something happens that seems wrong, but is actually allowed. The most common example is when you get hurt at work, your case is accepted, your benefits are paid, often for a long time and then they get denied. It’s not unusual for your claim to be accepted for a year or more and then suddenly you get a letter saying you have no case.
This usually happens when someone is hurt at work and the insurance adjuster takes their doctor’s word that it’s work related. Eventually a certain amount of money gets paid out on the case which in the insurance company triggers a review by a more senior person. They do this because they don’t want to pay a lot on any case. This senior person will come up with a strategy which often involves sending the worker to an IME which is an appointment with a company chosen doctor who will evaluate you and offer an opinion on what treatment you need and if your injury is work related.
This doctor often is a hired gun who makes a ton of money by writing reports that benefit the insurance company. If they do, the insurance company can deny your case. They are not your doctor and they aren’t looking out for you.
So how is this legal if they’ve paid out benefits for a year or more?
Under Illinois work comp law, payment of benefits is not an admission of liability. If they discover new evidence on your case such as you posting on social media that you really weren’t hurt at work, they can cut you off. And as shady as it may seem, their IME is new evidence which can be used to deny a case even after it was initially accepted.
A recent caller to our office had been receiving benefits for about 18 months when his shoulder injury got denied after an IME who said the injury was from something that happened ten years prior. It’s a ridiculous reason to deny a case, but it is allowed under Illinois law.
The good news is that it’s a solvable problem. Arbitrators at the Illinois Workers’ Compensation Commission aren’t stupid. They know who the hired gun doctors are and they don’t usually give much weight to their opinions, especially when your treating doctor is reputable.
Quite honestly, this is one big reason to have a lawyer even when the case is accepted. You’ll have someone who can prep you for the IME and if your benefits do get cut off, getting before an Arbitrator will happen much faster. Prepare for the worst and hope for the best is our motto.