One of the basic premises of Illinois workers’ compensation law is that your employer (usually via their insurance company) has a right to send you to a one time medical exam of their choosing. These are called independent medical examinations or IME’s. Those doctors aren’t there to treat you, but instead are supposed to evaluate your injury, treatment plan, discuss if it’s work related, etc.
In theory this makes sense. I’m sure when this law was crafted the thought was that the insurance company would pick out a reputable doctor to just double check that everything that is happening makes sense. In reality that’s not how it works.
Many of the IME doctors insurance companies choose are hired guns and in most cases will say what the insurance company wants. It’s big business and a lot of these doctors make over a million dollars a year from these exams and subsequent depositions. Some of these doctors have one day a week where this is all that they do. The exams last just a few minutes and it’s all profit. So they are motivated to err on the side of the insurance company or risk losing the gravy train.
Some doctors have such a bad reputation that I’ve heard Illinois Workers’ Compensation Commission Arbitrators say that they won’t give their opinion any credibility. Most are smart enough to occasionally find in favor of the worker so they can appear objective. But I recently came across one that seems like the scummiest one of them all.
This was a downstate case where a worker tore a muscle in his shoulder while lifting. Because it’s downstate I used our state wide network and referred it to a great southern Illinois work injury attorney. The worker contacted me because after he had a surgery recommendation, the insurance company sent him for an IME. That doctor said that no surgery was needed and the problems were really in the neck. Mind you that this worker had a MRI and no problems lifting his arm before the work accident.
It was one of the most bizarre IME denials I’d ever seen so I asked the downstate lawyer about it. He told me that the doctor doesn’t have an active practice. That means he’s not seeing patients, but instead keeps an office just to do IME’s. That will tell you how much money he makes from this. Apparently his “medical office” is a run down store front.
He also told me this: “Any time I see this doctor on a case, I know it will be a denial for some bizarre reason. And he flat out lies.”
I like making money as much as anyone, but I don’t worship money. And I like to go to sleep at night knowing I didn’t actively try to ruin someone’s life and health in favor of my pocket book. Some people just don’t worry about those things. I don’t get it at all how you can live that way. My guess is that he’s a miserable person.
The good news is that the worker is with a great attorney now who likely can get this sorted out. The doctor apparently has a terrible reputation with the Arbitrators downstate. And because his denial of surgery makes absolutely no sense, the insurance company likely knows it’s a losing battle. Their hope, I believe, was that he’d go away. Instead he was smart and got an attorney to push back.
If I had my way, we’d adopt standards for IME doctors in Illinois. They certainly should be board certified and maintain an active practice. I think if we limited the number they could do a year to maintain credibility it would help. Even if they could “only” do 100 a year it would prevent the out and out whores from being involved to such a great degree.
But the best thing that could happen would be if the Illinois Workers’ Compensation Commission set up an IME panel that doctors had to apply to and had standards. Then instead of picking an IME, the insurance company would have to request one and the Commission would assign one in the right specialty. This would take financial motivation away from doctors to lie as they wouldn’t be dependent on the insurance company to get business. And it would likely prevent insurance companies from seeking out IME’s when they know they should just approve a claim.
