Although Illinois workers compensation laws are generally worker friendly, the employer and their insurance company do have rights that protect them too. They are allowed to contest a claim for good cause such as a failure by the injured worker to notify them of an accident within a timely basis. Another right that they have is to schedule you for an independent medical examination or IME.
An IME is a one time (typically) exam by a medical doctor of the insurance company’s choosing. When you normally see a doctor, they have an ethical duty to you because you are their patient. With an IME, you will undergo a medical exam, but you aren’t a patient. In other words, that doctor doesn’t owe you any duty. They are paid for by the insurance company and often make hundreds of thousands of dollars a year from doing these exams.
What is crazy is that quite often, this “exam” will last less than five minutes. While the doctors have access to your medical records too and that can influence their report, it’s shocking how many injured workers report that the IME asked almost no questions and barely looked at them.
After their exam, the IME doctor will typically issue a report that tells the insurance company what their findings are and answer specific questions the insurance company wants answered. Those questions can include:
- What is your injury?
- Is it work related?
- Do you need the surgery the treating doctor is recommending?
- Do you have the ability to work now?
I’ve seen reports generated the same day of the exam. That’s not uncommon when you have a doctor who is doing hundreds of these exams a year. Typically their nurse or someone else prepares the meat of the report. Even when that doesn’t happen, the insurance company wants to get value for their money so you’ll find the report is prepared with in a week or two at most.
While they are waiting for the report, the insurance company might (often illegally) keep your case in limbo. They’ll say that they can’t approve a surgery until they hear what their chosen doctor has to say. They’ll tell you that they will send you a copy of the findings when they are available.
Days and weeks will go by and you’ll hear nothing. Why does this happen?
The most common reason you don’t get a copy of the report is because the company doctor agreed with your treating doctor. That is evidence that can be used against them, so they don’t want to give it to you. And believe it or not, there is no requirement that they do so. What they can’t do is know that they have no defense and continue to delay or deny your claim. But of course that happens. We can try to subpoena the report, but that isn’t always successful.
The other reason you might not get a copy is because a report doesn’t exist. While these doctors typically find in favor of the insurance company, they don’t do that 100% of the time. And since they want to keep their insurance company client happy, they’ll call them, tell them what the report would say and then agree to not put their opinions in writing.
It’s shameful because this isn’t about them finding out the truth, it’s about them trying to screw you over. The good news is that under Illinois law, if an IME happens and no report is presented, it’s assumed by the Arbitrators who decide your case that the report would be in your favor. In other words, even if there’s no report it can help you win your case.
Generally speaking, if it takes more than two weeks to hear back, I’d be suspicious. That’s the time to get a lawyer if you haven’t already. We can file a motion for immediate trial hearing which will force their hand and hopefully get your case on track. If you’d like our help with this, call us at 888-705-1766 any time. We help everywhere in Illinois.