When you file a workers’ compensation claim in Illinois, you may be required to undergo an independent medical exam (IME) by your employer’s insurance company. Injured workers are entitled to benefits under the no-fault Illinois Workers’ Compensation Act, which covers lost wages and medical expenses regardless of how the injury occurred. Understanding the IME process and preparing for it is crucial in protecting your rights to compensation.
For assistance with your claim, contact the attorneys at Chute, O’Malley, Knobloch, and Turcy, LLC at (312) 775-0042.
What Is an Independent Medical Exam in Illinois Workers’ Compensation Cases?
In workers’ compensation cases, employers’ insurance companies may request an Illinois Independent Medical Examination, which is often referred to as a Section 12 exam. This examination is conducted by an independent doctor who assesses your job-related injury and offers insights regarding your medical status, the required treatment, and your capability to work. The process includes a comprehensive medical evaluation and an examination of your medical records, culminating in a report that can greatly impact the result of your claim.
The Purpose of an IME
An Independent Medical Examination (IME) is an assessment conducted by a physician selected by your employer’s insurance provider. This appointment is not intended for treating your injury; rather, the physician is tasked with evaluating your condition, determining if it relates to work, and assessing your recovery progress. Following the examination, the doctor will prepare a report for the insurance company. The primary objectives of an IME include:
- Evaluating the specifics of the work-related injury and its severity.
- Determining the cause of the injury as much as possible.
- Providing a diagnosis and suggesting possible treatments.
- Outlining work limitations that may apply.
- Establishing a projected date for when maximum medical improvement can be expected.
Independent medical examinations can also be utilized to contest your qualification for workers’ compensation benefits in Illinois.
Why an IME Might be Requested
Insurers often seek third-party exams, known as Independent Medical Evaluations (IMEs), to dispute claims and reduce their financial liability. They might request an IME if they doubt the work-related nature of your injury, disagree with your doctor’s assessment, or believe you’ve fully recovered and want to end your benefits. IMEs are often used by insurers to cut costs or deny claims.
Workers cannot refuse or delay an IME without risking a suspension of compensation until the exam is done. Preparation with an attorney is crucial, as every aspect of the exam is significant. Always provide honest and accurate information during the IME.
How an IME Can Affect Your Workers’ Compensation Benefits
An IME can adversely affect your Illinois workers’ compensation benefits in various ways. If the IME doctor’s opinion contrasts with that of your treating physician and tends to favor the insurance company, it could result in a reduction or termination of your benefits, denial of future medical treatments, or a diminished permanent disability rating.
To safeguard your claim, attend the examination and be truthful yet concise. Avoid exaggerating your symptoms or providing unnecessary information. Seeking legal advice prior to the IME is also recommended, as the report generated from this examination carries considerable influence.
Reduced or Terminated Benefits
If the IME doctor concludes that your condition is less severe than your treating doctor reports or determines that you are fit to return to work, the insurance company may leverage this finding to decrease or end your wage replacement benefits.
Denial of Treatment
The insurer might use the IME results to dispute the necessity or appropriateness of ongoing or future medical treatments, which can lead to a denial of coverage.
Lower Permanent Disability Rating
The conclusions drawn from your IME regarding your permanent impairment or disability can affect the size of your final settlement or award.
Authoritative Assessment
The IME report carries weight with insurance companies, often regarded as an authoritative evaluation of your condition.
Why You May Need an Illinois Workers’ Compensation Lawyer for Your IME
If you’re facing an Independent Medical Examination (IME) in Illinois, seeking the guidance of a workers’ compensation attorney is essential. An IME can influence your benefits, and having legal support can help you prepare effectively, reducing the chances of complications with your claim. If the results of the IME do not accurately represent your condition, an attorney can assist you in challenging them and may file emergency motions in court to safeguard your rights. An Illinois workers’ compensation lawyer can prevent mistakes in your claim and advocate against insurance companies that might attempt to deny your benefits.
An attorney can help with other issues that may arise in a claim, such as if you have a pre-existing injury or are unsure whether to file a case. Injured workers may not be taking the necessary steps to file for available benefits. A 2023 study showed that between 20% and 91% of workers did not report their injuries or illnesses to their employers or to workers’ compensation programs.
If you’ve been asked to undergo an IME following a workplace injury, contact us at Chute, O’Malley, Knobloch, and Turcy, LLC. Our team is well-versed in the Illinois workers’ comp case timeline and can guide you through the IME preparation process.
Frequently Asked Questions About Independent Medical Exams
Is the IME Doctor Genuinely Independent?
Although the term “independent” is in the name, it’s more fitting to refer to it as a Section 12 exam, since the insurance company selects and pays the doctor. Their report could be used to reduce or eliminate your workers’ compensation benefits.
Do I have Patient Confidentiality With the IME Doctor?
Since they aren’t your personal doctor, IME doctors are required to report everything you discuss to the insurance company.
Will I be Asked Questions During My IME?
You will be questioned during your IME. It’s important to answer all questions truthfully and thoroughly. Be cooperative, but don’t provide information unless they ask for it. Remember, concise is often best.
