If you’re facing a denied claim or diminished benefits after a work injury, one of the most important actions you can take is to challenge an IME report to obtain the financial support you need. The Illinois Workers’ Compensation Act allows employers to request that injured employees see a physician of their choice for an examination. While termed “independent,” these medical evaluations are often biased towards the insurer’s interests. If your benefits are suspended or surgery is denied based on these findings, it’s crucial to act swiftly to safeguard your livelihood.
For help with disputes about medical care or benefits in Naperville, contact Chute, O’Malley, Knobloch & Turcy, LLC at 312-775-0042.
Why Employers Dispute Work Injuries and Rely on IME Reports
In Illinois, employers frequently challenge workers’ compensation claims to manage insurance costs and reduce liability while preventing fraud. They often use Independent Medical Examinations (IMEs) to gain a second opinion on the injury’s work-relatedness, severity, and treatment needs. This approach helps verify claim legitimacy and minimize financial risk for employers.
The primary reasons for IMEs include:
- Cost Management: By encouraging employees to undergo an independent medical exam, companies can mitigate costs through intentional provider selection.
- Fraud Prevention: Retaining a trusted medical evaluator gives companies a sense of control over fraudulent claims.
- Disputes Over Causation: Medical exams help tie the injury to the workplace accident or working conditions.
- Issues with Documentation: Using a provider familiar with the workers’ comp process can help ensure documentation is properly completed.
IMEs provide what is often perceived as an “impartial” evaluation, which may challenge the conclusions of the treating physician regarding injury severity or the necessity for additional, costly medical treatment.
Disputes are common in Illinois. The Illinois Workers’ Compensation Commission reported 34,366 new claims in 2024.
IME Reports as a Way to Dispute Your Claim
The primary reason employers or their insurance carriers use IMEs is cost control. Workers’ compensation insurers aim to reduce liabilities from long-term disability or costly surgeries. By sending you to a selected doctor for a one-time evaluation, they hope to acquire an opinion that contradicts your treating physician, particularly if you’ve aggravated a pre-existing injury.
The IME doctor is not your treating physician and lacks a doctor-patient relationship with you. Their role is to review your medical records and conduct a brief physical exam to answer specific questions from the insurance adjuster. Since these doctors frequently see insurance-referred patients, they may be viewed as repeat customers, creating financial incentives to produce reports that support benefit denials.
Typically, if the IME doctor disagrees with your treating physician, the insurance company will favor the IME’s assessment, resulting in an Illinois work injury dispute that may need legal intervention.
How to Challenge an Independent Medical Examination (IME) in Illinois
To challenge an IME report, you need a counter-argument supported by medical evidence. Simply disagreeing with the findings of the IME doctor won’t sway an arbitrator to restore your benefits.
This process involves gathering expert testimony, identifying procedural errors, and leveraging the workers’ comp timeline. Under the Illinois Workers’ Compensation Act, an unfavorable IME report can jeopardize your benefits, but it’s not the end. Effective strategies to contest it include:
File a 19(b) Petition
Start by preparing a 19(b) petition for an immediate hearing. This is crucial when an employee’s medical services or TTD benefits are halted. If benefits are cut due to the IME, an Illinois workers compensation attorney can expedite the process to get before an Arbitrator to reinstate those benefits.
Request the IME Report
Promptly obtain the IME report to check for errors, such as missing tests or misstatements.
Rebuttal from Treating Physician
Have your treating physician review the IME report and write a rebuttal that identifies inaccuracies and emphasizes their broader treatment perspective. Illinois law typically favors the opinion of a long-term treating physician over that of an IME doctor who has seen the patient briefly.
Highlight Bias
If the IME doctor is known for biased reporting, this should be presented to the Arbitrator. If the report is patently false, consider filing a petition against the insurer for unreasonable denial of benefits.
Depose the IME Doctor
A workers’ compensation attorney can depose the IME doctor, who must defend their findings and disclose the fees they received for the evaluation. This can expose biases and highlight the brief nature of the examination.
Compensation You Can Recover After a Disputed IME
A negative IME report is only one piece of evidence and does not determine the final decision. Successfully challenging this report before an Arbitrator can help you obtain full benefits. The goal is to show that medical evidence supports your case over the insurance company’s physician. This is important if your workers’ comp case is denied, as you may face medical bills without income. If you win, the insurance company typically must pay all back benefits and medical costs.
This includes coverage for reasonable medical treatment and necessary care to address your injury, as well as expenses for required surgeries that the IME doctor may have denied. For wage replacement, you can receive Temporary Total Disability payments if you are unable to work, even if the IME suggests you can. Additionally, you might qualify for Temporary Partial Disability payments if you’re back at work but earning less, or for Permanent Partial Disability compensation if you suffer a lasting impairment.
If the injury prevents a return to your previous job, you can seek recovery for costs associated with vocational rehabilitation and necessary training. Lastly, if the insurer is found to have acted vexatiously and unreasonably in denying your claim, they may be required to pay penalties and fees as punishment for their actions.
Challenging an IME report means advocating for accurate medical assessments. An independent medical examination in Illinois should be impartial. If it isn’t, the legal system offers a way to address that. Successfully disputing it can restore your benefits and ensure your health is prioritized over insurance profits.
Contact us at Chute, O’Malley, Knobloch & Turcy, LLC to discuss how a committed workers’ compensation attorney can help you achieve a fair resolution.
Frequently Asked Questions
What is an IME and why does an employer require one in Illinois?
An IME, or independent medical examination, is conducted by a doctor selected by the employer’s insurance company. In Illinois, employers can request this exam to independently validate the details of a work injury. However, these exams are often used to deny or reduce benefits.
How can an IME report be challenged in a workers’ compensation case?
You can challenge an IME report by submitting a rebuttal from your treating physician, pointing out factual inaccuracies in the report, deposing the IME doctor to highlight bias, and presenting evidence of your actual physical limitations to an Arbitrator at the Illinois Workers’ Compensation Commission.
Can benefits still be received if an employer disputes a work injury?
If an employer contests a claim based on an IME, you can file a 19(b) petition for an emergency hearing. If the Arbitrator determines the injury is work-related and the IME was flawed, the employer must cover all owed benefits, including medical expenses and lost wages. An employer’s dispute or a negative IME report does not end your eligibility for benefits. You can continue pursuing them through litigation.
