An Independent Medical Exam (IME) is an opportunity for the employer (really the employers workers compensation insurance company) to have you examined by a doctor of their choosing. Legal authority for this exists in Section 12 of the Illinois Worker Compensation Act:
“An employee entitled to receive disability payments shall be required, if requested by the employer, to submit himself, at the expense of the employer, for examination to a duly qualified medical practitioner or surgeon elected by the employer, at any time and place reasonably convenient for the employee.”
As the injured employee is allowed to select a doctor of his or her choosing for medical treatment Section 12 is largely a fairness doctrine that allows the employer/insurance company to make certain that there is a) an ongoing injury; b) related to one’s job; c) that is sufficient for the employee to be off work; and d) may require future medical treatment. Absent this provision, the insurance company would have no recourse in challenging the treating doctor’s decision making. The Illinois legislature recognized that this could result in detriment to the employer, which might have to pay unfounded benefits to the employee.
Preparing for Your IME
At Lipkin & Apter, we talk with our clients before the meeting with the IME. We explain that the IME doctor is not going to engage you in a doctor-patient relationship, will not offer you advice, or medical treatment or share with you his opinion on causation.
We explain that the IME has been hired by the workers compensation insurance carrier essentially to determine whether you are entitled to receive ongoing Total Temporary Disability (ttd) permanent disability and medical benefits. Being paid for exclusively by the insurance company and sometimes enjoying a relationship with the insurance company that goes on for years, and pays the IME hundreds of thousands of dollars, can result in a bias in favor of the employer. It is important that you be prepared for how to answer questions likely to arise during the IME meeting. For instance, you must honestly tell the IME about the severity of your pain, activities which may exacerbate your pain, and how it effects you.
Why TTD Payments May Be Delayed
An IME may be scheduled by the employer at any time, even multiple times, and is frequently a reason why payment of temporary total disability (ttd) or medical benefits are delayed. For instance, an injured worker complaining of low back pain following a lifting injury may be recommended for spinal surgery by his treating doctor. Before authorizing surgery, the workers compensation insure may want to determine whether the surgery is actually warranted, by having a doctor of their choice examine the patient. Following the exam, the IME doctor must then generate a report with their findings. If the report finds the need for surgery is appropriate and connected with a work related accident, the insurance company will authorize payment. If not, the insurance company will deny authorization.
When Medical Professionals Disagree
A similar circumstance exists when your treating doctor says you should remain off work and the IME says you are able to return to work.
One thing is certain- the workers compensation insurer is going to follow the recommendation of its hand selected IME. And if this means that ttd or medical benefits are denied,the insurance company will deny benefits. This is financially beneficial to the insurance company, and is legal, but places the injured worker in a quandry. What to do?
Where the IME denies payment of ttd, the employee may seek trial to have an Arbitrator force the employer/insurance carrier to pay. This could take weeks, or even many months, before trial occurs, and the Arbitrator writes his decision. The employer could always appeal an adverse decision, forcing the worker to go still longer without receiving ttd.
Lipkin & Apter Independent Consultation
When this issue arises at Lipkin & Apter, we explore with our client whether they have the financial ability to withstand a lengthy period without receipt of ttd. Few do. There is an alternative. An IME recommending that the injured worker return to the work place is really making a prediction- that the individual will be able to perform his job. Proof can only occur with actual experience. If he can, the worker benefits with receipt of his regular paycheck. If not, then the IME’s prediction has been disproven, and ttd should resume. With this in mind, we always explore with our client what his circumstances are, and whether he wants to go to trial, or try returning to work. This is an example where explaining the law and the opinions of both the IME and treating doctor enables our clients to make the best decision for themselves and family. At Lipkin & Apter we do not impose decisions. Rather we bring you into the decision making process so you know the “whys” and “wherefores” and can make the right decision for you. Of course we are not hesitant to share with you our ideas based on the law and facts of your case.
Your Health Is Priority One
A similar situation exists when an IME denies the medical treatment recommended by your doctor. If you have group health insurance you could always undergo the recommended treatment paid for by group health. But ttd will likely be denied. Or we could go to trial on the limited issue of whether the medical treatment is necessary and related to your work accident. Again, this could take months, and a favorable opinion could be appealed. Or you could try returning to work without the medical treatment, and see how you respond. We believe that the decision to hold out for medical treatment is the most important issue in your case. As we like to say, “you have only one body”, and there is nothing more important than taking care of it. Even financial benefits are secondary to health issues in our view.
Another stratagem if an IME states an unfavorable opinion is to send the IME report to the treating doctor for comment. Often times the treater will provide reasons why the recommended treatment is warranted, or why the IME opinion is unfounded. These comments by your treating doctor are especially valuable at trial, and can be decisive in the Arbitrator ruling in your behalf.
Learning Your Options with Lipkin & Apter
An IME is a fact of life in many workers compensation claims, and can be anticipated where ongoing or expensive medical treatment has been recommended by your treater, or when you are out of work for a long period of time. Explaining what an IME is and preparing you for it, as well as explaining your options in the the event the IME opinions are an important aspect of the representation you will receive at Lipkin & Apter.