Under the Illinois Workers’ Compensation Act, the insurance company is allowed to send you to a doctor of their own choosing. This is called a Section 12 exam as it’s from Section 12 of the Act. It’s more commonly known as an IME or Independent Medical Examination.
If you read this blog or if you’ve had a work comp case in the past, you likely know that these exams aren’t really independent in most cases. And they often aren’t really exams. Quite often the “exam” lasts less than five minutes and the doctor authors a report based on what the insurance company wants them to say.
But not every IME is a hired gun and in some cases they couldn’t refute the case with a straight face. I’d say one out of every 15-20 IME’s actually confirms what the treating doctor says about your injury and also relates your problems to your job.
So what happens next?
In a sane world, there would be no disputes and the insurance company would authorize your medical care (often a surgery) and time off work and move on to the next battle. In reality that doesn’t always happen.
The most common thing we see is them failing to turn over the IME report to you at all. If it’s been more than two weeks and they say the IME report isn’t ready yet, it’s probably a lie. If it’s more than a month later it’s almost certainly a lie. They figure if you can’t see the IME maybe you’ll use your own insurance or choose to go back to work because you have no money coming in.
The solution is to subpoena the IME doctor for their report and also file a 19(b) petition for immediate hearing to force their hand.
In other cases the insurance company will tell the doctor not to prepare a report if they won’t agree with them. They will call the insurance adjuster after the exam and tell them verbally what they’d say. In theory, if they don’t write down that they agree then they really didn’t agree. In reality, if an IME takes place and no report is written, it’s assumed by the Illinois Workers’ Compensation Commission that the finding would have been in your favor.
Another crazy strategy these insurance companies try at times is to try and send you to a brand new IME. If at first you don’t succeed ….
They can ask you to do that, but you don’t have to go to a new IME if it’s not addressing a new issue. And you shouldn’t go, especially if the first IME wasn’t turned over. I can’t recall one time in 26 years seeing a valid second IME within weeks of the first one that wasn’t with the same doctor.
Bottom line is that this event is rare, but happens and is great news for you. It doesn’t mean the insurance company will stop playing games, but it means that at least in the short term your case is looking great.
As always if you have any questions and want to talk with an attorney for free, call us at 312-346-5578. We help everywhere in Illinois.