If the insurance company sends you a letter and claims you are required to attend an exam with their doctor, do you have to go?
In a word: Yes.
Your employer will both select and pay for this doctor to examine you to give an opinion regarding the nature and extent of your injury, and the necessity of the medical care that has been recommended to you. This is called an “independent” medical exam, which we have discussed in, ‘“Independent” Medical Exams (IME’s) in Workers’ Comp Cases: What Are They and What Are My Rights?’
Often, but not always, these doctors are selected for their conservative opinions regarding the extent and nature of your injury and what treatment might reasonably be necessary.
All such examinations are conducted under the terms of section 12 of the Illinois Workers’ Compensation Act, and there are several requirements that your employer must meet. For example, they must pay for the expense of travel to and from the examination, and any wages that you are entitled to during the period to and from and during the course of the examination. The travel expenses must accompany the initial letter requiring your attendance, but rarely is this done properly by the insurance company.
This situation should set off a light in your head that you need legal representation. While these examinations can be conducted by excellent doctors, more often than not, they are conducted by doctors that no longer truly practice medicine, or who see this practice as a way to supplement their income. By their very nature, these types of examinations, in most cases, result in separating you from your medical care and the receipt of workers’ comp wage benefits, such as temporary total disability, otherwise known as TTD.
I recommend to all those who suffer a work injury that if they get such a letter regarding an upcoming independent medical exam, then it’s time for them to hire me or another competent attorney to instruct them regarding the Section 12 Independent Medical Examination.
What happens if you decide not to go to the exam?
If you decide not to attend the “independent” medical exam, then your benefits will be suspended until such time as you comply with this request. You will not receive weekly wage replacement benefits (TTD) or have further medical treatment. All benefits will be suspended by the workers’ comp insurance carrier, which, in such a situation, they would have a right to do so under Illinois law.