IL Work Comp – If I Miss A Doctor’s Appointment Can They Cut Me Off?

Under Illinois workers’ compensation law, you as an injured worker are required to cooperate with reasonable medical care. That’s kind of a vague statement, but in general you are supposed to follow what the doctor recommends, although you can’t be forced to have surgery. If you don’t like what they have to say, you are entitled to a second opinion.

Part of cooperating means showing up to appointments. A recent caller to my office missed two physical therapy sessions and wanted to know could his work comp benefits get cut off because of that? I think this calls for a bigger blog post on what can happen if you miss a doctor’s appointment.

Generally speaking, you could be cut off for missing a doctor’s appointment or a PT session, but it’s really rare that a one time miss would cause a suspension of your benefits. So how many appointments can you miss? There’s no right answer, but the more you miss, the greater at risk you are. Insurance companies don’t like paying anything on your case and they certainly don’t want to pay for missed appointments. There’s also the issue that you not going causes the case to drag on longer.

So I’ve seen people cut off for as little as two missed appointments, but in my experience it’s usually somewhere between 3-6 where it becomes a problem. Missing a doctor’s appointment is worse than missing a PT session for sure. If the worker is represented, their lawyer will often get a call to find out what is going on, although it’s possible the benefits just get suspended. In my experience, if you have a good reason for missing you are less likely to be suspended. That would include being sick (COVID especially), having a funeral, car breaking down, etc. If you are going to miss, we highly recommend that you call the doctor ASAP to notify them.

The insurance company has a right to send you to an IME which is a one time doctor’s visit of their choosing. Even though a lot of these doctors are hired guns, you have to go to the exam if they provide you proper notice and travel expense. If you don’t, missing that one time exam will usually be enough to get your medical and TTD benefits cut off and they usually can get away with it.

So how do you get your benefits back if they get cut off for missing medical appointments? The answer is you show that you will be compliant. If you miss an IME, we try to get you in to the next open date. If you have missed some physical therapy or a doctor’s exam, we let them know why and make clear that it won’t happen again. They do have a motivation for you to get healthy, so often that’s enough.

But if you say you won’t miss any more and do without a valid reason, you are likely looking at a termination of your benefits that might hold up in court. In other words, you could have a great case otherwise and an Arbitrator won’t be sympathetic and will side with the insurance company. They may even say your case is over beyond getting a settlement.

The bottom line is that work comp in Illinois is the best healthcare you can get. There are no co-pays. No out of pocket expenses. You can typically pick your doctor. Don’t screw it up by not making your appointments. If you do have to miss one, let the doctor and your lawyer (or the insurance company if you don’t have a lawyer) know why ASAP and don’t make it a habit.