Pursuant to the law under the Illinois Workers’ Compensation Act, a workers’ compensation insurance company has the right to request that an injured worker sees a doctor of their choice for an “Independent Medical Exam,” which the injured worker is required to attend. Failure to attend this examination will result in workers’ comp benefits being stopped, which includes temporary total disability (TTD), as well as all medical care, such as physical therapy, prescription pain medication, doctor visits, ordered surgery, and so forth. By law, the workers’ compensation insurance carrier must send the employee a travel check prior to the appointment to cover for his or her travel expenses to and from this exam. If complying with the scheduled examination causes the injured worker a loss of wages, then the employer must provide reimbursement for the wages, in addition to the check for travel expenses.
Regarding “Independent Medical Exams” in Illinois workers’ comp cases, the term “independent” is extremely misleading, and, usually, it is simply not the truth. While some physicians with a stronger level of ethics will provide you with a fair and truly “independent” assessment of your injuries, such doctors are more the exception than the rule. Based on my 44 years of practicing workers’ compensation law in Illinois, the sad truth is that the workers’ compensation insurance company pays these hired “independent” medical exam doctors exceedingly high amounts of money for each individual exam, and, as a logical result, many of these exams are anything but “independent.” If the doctor desires to be hired and paid for future exams, and if the doctor does not have the highest standard of ethics, then he or she knows that it would be in his or her best financial interest to minimize the medical care costs that the insurance carrier has to pay out. The way for this to be done is for the doctor to do everything in his or her power to medically argue against the injured workers who attend these exams, either by denying that the injuries were caused by their jobs, and/or by arguing against the treating doctor’s more expensive orders for future medical care. Common “Independent Medical Exam” reports use phrases such as: “The patient’s injuries are not work-related,” and “The ordered treatment is not medically necessary.”
For example, here is a common scenario: A technician for a telecommunications company has job duties which include working on his feet for eight hours per day, lifting heavy equipment, and climbing ladders and poles. One afternoon on the job, he is at a job site in Wheaton, a western suburb of Chicago, Illinois. He steps onto an uneven patch of grass while carrying heavy equipment, and he twists his right knee. He reports the injury immediately to his supervisor, and seeks medical care right away. A week later, he is contacted by the workers’ comp insurance adjuster, who states that, in order for the injured worker’s claim to begin, he must provide the insurance company with a recorded statement. The technician, believing what he is told, gives a recorded statement on the phone. Because he does not have the advice of an attorney, he does not know that he is not required to provide such a statement. The technician is lucky because they do not use his statement to deny his claim. Instead, the claim begins, and, for a few months, everything is going well, the insurance company pays him TTD (temporary total disability) for his lost time, and all his medical bills for the injury are paid on time. Then, one day, he receives a letter in the mail notifying him of a required “Independent Medical Exam” with a doctor at a well-known and respected medical institution. He attends the exam, and answers all questions openly and honestly. The doctor is well-qualified, and appears to be honest, friendly, and kind. However, weeks later, the technician learns that his entire workers’ comp claim is now being denied on the basis of his recent “Independent Medical Exam,” which included a report by the doctor stating that the client’s knee condition was not work-related, but actually a well-known pre-existing condition called arthritis.
“Independent Medical Exams” are one of the most common weapons that insurance companies use to deny workers’ compensation claims. The sad truth is that the vast majority of the time, these “independent” exams reach conclusions that are not in favor of injured workers, while many doctors create steady streams of income by taking the side of the insurance companies as often as possible. The best weapon for an injured worker to fight back is to hire a qualified workers’ compensation lawyer who can take the insurance company to court at the Illinois Workers’ Compensation Commission. If you have an upcoming “Independent Medical Exam,” I urge you to call an attorney before the exam for a free and confidential consultation, so that he or she can advise you of your rights, and inform you of what to expect at your upcoming exam. It is in your best interests to speak with an experienced attorney before you see the “independent” doctor. There are some things you simply cannot find on the internet, including the knowledge experienced attorneys have about which doctors are fair and which doctors are not, based on the many “Independent Medical Exam” reports one can study throughout years of practicing law.