Independent Medical Exam

medical exam

Many injured workers pursuing a workers’ compensation case receive a letter telling them to attend an independent medical examination.

Do they need to attend?

Who chooses and pays the doctor?

What impact does this exam have on their worker’s comp case?

While independent medical exams may be part of your workers’ compensation claim, there are several ways to navigate them with proper guidance from your attorney.

Nothing Independent About This Medical Exam

First of all, there’s nothing remotely independent about an insurance-required medical exam. If an insurer disagrees with your doctor’s evaluation or feels you are taking too long to recover and return to work, they can use the exam as a tactic to get their way. The exam, formally known as a Section 12 exam, is pursuant to (you guessed it) Section 12 of the Illinois Workers’ Compensation Act. Section 12 provides that the employer (and in reality, its insurer) can request that the injured employee attend such an exam at a doctor of its choosing.

The doctor chosen for an Independent Medical Exam is typically selected from a list of providers who are “friendly, frequent flyers.” The insurance carrier uses these frequent flyers, a list of usual suspects if you will, to examine injured people knowing these doctors have historically been friendly to the insurers’ position. Think about that. Doctors who will be paid upwards of $2,000 per exam by the insurance company might be more than a bit biased in attempting to minimize the severity of an employee’s injuries, send them back to work sooner, or dispute the findings of the employee’s treating physicians.

Who Pays for the Exam?

The insurance company pays the doctor. As stated above, there is a significant influence that comes with that payment. Doctors want to continue to receive more evaluations from that insurer. By writing reports that are generally favorable to the carrier and harmful to the employee, they accomplish this purpose.

What Impact Will a Section 12 Exam Have on the Case?

After the exam, the report gets sent to the insurer, who also forwards it to the employee’s lawyer. In many cases, the doctor finds the injuries merit no further treatment. This provides the insurer with the pretext to “cut off” the employee from further benefits for TTD (Temporary Total Disability) and medical payments. It forces the employee to make a choice: go to trial down the road (months, if not longer) in the hope that their own doctor will be more persuasive to the hearing arbitrator or cave and settle.

Starving a worker is an unfortunate tactic used, and the Section 12 Exam is just one way in which this tactic manifests itself.

What Can/Should You Do?

Go to the exam. If you don’t, you will be immediately “cut off” from all benefits. It’s not ideal, but it is required.

At the exam, let the doctor examine you, but do not interact. Do not volunteer any information. Additionally, be sure to talk to your lawyer before you go to ensure you fully understand what’s coming.

Contact Chicago Workers’ Compensation Lawyer Stephen Hoffman

As in all cases involving injury and potential liability, immediately get medical treatment and contact a lawyer with expertise in your type of case, such as workers’ compensation.

If you've been in a workplace accident and have questions, contact Chicago workers’ compensation attorney Stephen L. Hoffman for a free consultation at (773) 944-9737. Stephen has nearly 30 years of legal experience and has collected millions of dollars for his clients. He is listed as a SuperLawyer, has a 10.0 rating on Avvo, and is BBB A+ accredited. He is also an Executive Level Member of the Lincoln Square Ravenswood Chamber of Commerce. Don’t wait another day, contact Stephen now.

Categories: Insurance, Work Injuries