Under Section 12 of the Illinois Workers’ Compensation Act, the employer/insurance company has a right to send you to a one time doctor’s visit of their choosing. This is called an independent medical exam or IME. These are quite often doctors who makes hundreds of thousands of dollars a year from seeing patients for what are usually five minute or less exams. They review your medical records and then write a report which commonly says whatever it is the insurance company wants them to say.
We know who the hired guns are and fortunately so do most Arbitrators. Not every IME doctor is a hired gun of course and sometimes they give an honest evaluation which agrees with your doctor. Other times there is literally no way they could say you don’t need a surgery or that your problems aren’t work related. That’s typically when you’ve gone through a lot of physical therapy and failed and/or your MRI shows a clear cut problem.
When this happens it pisses off insurance adjusters. Those companies don’t like to give money away. Usually they’ll just deal with it and approve your treatment. But every now and then they try to send you for a second IME. The question is, can they?
This case up with a recent caller. He had a back injury and his doctor wants to do surgery. The insurance company sent him to an IME with a neurologist who agreed with everything the treating doctor said. That should be that. But now the insurance company wants to have another shot at an IME saying that they should have had an orthopedic doctor look at it. Of course the one they picked is a well known hired gun who likely will say whatever the insurance company wants them to.
The caller wanted to know if they have to go to the IME. In this case I think it’s a BS second IME. That said, if he skips it, his benefits will get cut off, at least temporarily. When push comes to shove though I don’t think any Arbitrator would let them get away with it. So the worker is damned if he does, damned if he doesn’t, but I personally think the best course of action in this case is not to go.
The law basically is that they can have a second IME if the exam is addressing a new question. At times that can mean having a different type of doctor look at the case. If their first IME, the neurologist, had said that an orthopedic doctor is what is needed that would be one thing. That didn’t happen.
The common time when a second IME can happen is something like you had surgery after an IME and now six months later your doctor wants to do another one because you haven’t recovered. That’s a new issue. Or maybe they want to put in a spine stimulator. That’s also a new issue.
In this case though, the 2nd IME is just them trying to get another bite at the apple. They think they can push this worker around because he’s not represented. In a way they are right. If you don’t have a case filed with the Illinois Workers’ Compensation Commission, you don’t have any remedies when they break the law. The good news is that it’s an easy problem for a lawyer to solve.
In general, if an insurance company is seeking a second IME, it’s a clear cut sign they are trying to do whatever they can to end your right to benefits. That’s their goal in almost every case, but this is a hyper aggressive way to do it. It’s also a sign you have a serious injury and a lot on the line, so not hiring an attorney would be a huge mistake.
