If you are injured at work in Illinois, you have the right to choose your doctor and the insurance company has a right to send you to an IME or independent medical exam. It’s a one time (typically) exam and the doctor that you see is not there to look out for you. Instead they are there to offer an opinion on what your injury is, if it’s work related, what medical care you need and other things. They are often hired guns so it’s no surprise when they come up with a medical opinion that is wildly different than your doctor. It’s frustrating because this can happen after a five minute exam when your doctor has seen you many times.
Insurance companies do this because it allows them to deny benefits even when no reasonable person would agree with the IME. When that happens you are left with two options:
- Put your bills through your group insurance if you need treatment.
- Go to trial.
Going to trial is usually the best option. A lot of attorneys simply are lazy and won’t do it. That happened in a case where a worker called us recently. The IME was three years ago and the attorney has not gotten the case to trial. That’s unforgivable. When you go to trial, you have to beat down the IME opinion. That is done in two ways:
- Your lawyer will take the deposition of the treating doctor who can establish credibly what their opinion is and how they came to it.
- You take the deposition of the IME doctor and you show that their opinion isn’t as credible.
Recently we got the trial decision on a case of an injured construction worker who came to us for help with a back injury. The lawyer we had handle the case for him did a textbook job in destroying the IME opinion and the Arbitrator made that clear in his findings.
In this case our client is a union laborer who does demolition work and concrete work. It’s a heavy duty job. Part of his job involves lifting heavy drywall and moving mortar. While doing his job duties he injured his back. He sought immediate treatment and eventually went to a well known orthopedic doctor. He did conservative treatment at first which included physical therapy. When that didn’t work he had a MRI. The treating problem noted he had problems with his discs. Eventually he recommended a spinal fusion and said that it was related to the heavy manual labor work the client did.
When that happened he was sent to an IME who said the MRI was normal and the worker had a simple back sprain. Those are obviously two VERY different opinions.
The case went to trial and the worker won on every issue. It was partly because the Arbitrator saw him in person and viewed him as credible. And partly because the Arbitrator noted what the IME doctor got wrong. Here are some of the things that our lawyer did that won the case:
- He got the doctor to admit he wasn’t sure what some of the terminology was on a CT scan that took place. In this case he couldn’t define what “vacuum phenomenon” at L4-5 meant. The treating doctor was able to explain it and how it related to the diagnosis and symptoms.
- He got the doctor to admit he never reviewed x-rays that the treating doctor said confirmed part of the diagnosis. The Arbitrator noted he didn’t have a pertinent diagnostic study.
- The doctor said the worker only had a strain that should take 4-6 weeks to resolve but also admitted that the worker didn’t show any signs of faking his symptoms.
There wasn’t a Perry Mason-esque gotcha moment, but rather a chipping away at credibility by knowing what the doctor didn’t know. It gave the Arbitrator something to hang his hat on in deciding the way he did. Now the surgery is approved, all the owed medical bills are paid and the worker has been compensated for all of his time off of work.
It’s maddening he even had to go to trial, but awesome that it worked out and a great example of how to win even when the IME tries to screw you over.