What to Expect at an Independent Medical Examination
If you are injured at work, chances are high that the workers’ compensation insurance company or your employer will eventually require you to attend what is called an independent medical examination (IME). This is more accurately and more fairly called a “Section 12 exam” as it is set pursuant to Section 12 of the Illinois Workers’ Compensation Act. There is nothing “independent” about it. This is not an exam set with a neutral doctor to get an unbiased, neutral opinion. Instead, this is where the insurance company hires an expert of their choice to have you examined and, thereafter, offer an opinion regarding your injury.
The insurance company will then rely on this expert’s opinions when the case proceeds to trial.
If their Section 12 doctor opines that you can return to work, they will use that opinion to stop paying your temporary total disability benefits.
If their Section 12 doctor opines that you do not need any more treatment, they will use that opinion to stop approving necessary medical treatment for your work-related injury.
If their Section 12 doctor opines that your condition is not causally related to the work injury, the insurance company will use that opinion to deny all benefits.
Section 12 exams are, by and large, not favorable to injured workers.
So why then would an injured worker agree to attend a Section 12 or independent medical evaluation? Because Section 12 of the Act requires your attendance. If an employer schedules such an exam and provides reasonable notice of the same and reimburses the injured worker for the cost to travel to the examination, then the injured worker must attend. If they refuse, the insurance company can deny payment of benefits until there is compliance. But just because you have to attend does not mean you have to do anything more than attend.
What To Expect During IME or Section 12 Exam
An employer or insurance cannot force you to treat with or seek medical attention from a doctor. The only appointment they have the right to require you to attend is a Section 12 exam. You will know it is a Section 12 exam or independent medical examination by the fact that the notice will come to you in writing. It must give you the date, time, location and name of the doctor doing the exam. It also must provide you with a check reimbursing you for your travel expenses. This is usually per mile based on the reimbursement rate set by the government.
If there are expected tolls or parking tolls, these should be reimbursed as well.
If the exam will take the majority of the day, then they are also responsible for reimbursement of a meal.
If you do not receive travel reimbursement before the exam, then you are under no obligation to attend it.
The letter may instruct you to bring your medical records, x-rays and MRI films, or other material. You have no legal obligation to take those documents with you to the exam.
If you have the diagnostic test films in your possession, you could take them and allow the doctor to review them. It may allow the doctor to prepare the report faster rather than waiting for the insurance company to obtain it and forwarding them to the doctor’s review later.
If you elect to take them with you, do not leave them in the doctor’s possession. They are your films, and you should keep them when you leave.
NOTE: Contrary to some online assertions, your attorney usually will not attend this examination with you. Typically it will be just you and the examining doctor in the examination room. Whether your spouse or someone that accompanies you is allowed into the room is up to the doctor. A nurse case manager hired by the insurance company should not be allowed in the room without the consent of your attorney beforehand.
Although you should be prepared to tell the doctor about the injury, treatment and symptoms, it is not uncommon for the doctor to not ask the injured worker any questions or spend much time at all with them during the examination. They will do a cursory examination of the body part that was injured and sometimes an exam of the contrary body part for comparison (for example to compare the right arm's range of motion to the left arm.) They should not be examining any other body parts not involved in the injury.
It is also important to remember that they are examining the injured worker for signs of malingering or symptom magnification. For example, if you are to report how severe your pain is on a scale of zero to ten and you report the highest severity of a 10 but there are no obvious signs of distress like increased heart rate, increased blood pressure or crying, then they may use that to conclude the patient is malingering or exaggerating their symptoms. This can have a devastating impact on a case.
Do not expect the doctor to tell you their opinion, recommendation or to provide you with a copy of their report. They will write a report and tender it to the insurance company following the exam. This report often will not be released to you voluntarily by the insurance company and your attorney will likely have to force them to turn it over by threatening to proceed to trial— especially if the report is in your favor.
Hire a Trusted & Experience Rockford Attorney
A Section 12 exam is a strategic tool used by insurance companies to limit benefits or treatment. When used strategically, it can be detrimental to an injured worker. If you receive notice of the exam or if you are told an exam is being set, it is important to get an attorney to represent you. An attorney will likely be familiar with the doctor the insurance company has chosen and prepare you on what to expect from that doctor and the opinions likely to be rendered. If you have received such notice or attended an IME recently, call Black & Jones Attorneys at (815) 967-9000, or fill out this form for a free consultation. We represent injured workers in Rockford and Northern Illinois and are very familiar with the usual “experts” these insurance companies hire. We will prepare you and formulate a battle plan to fight to protect your rights.