In this article, we will answer a reader’s question: “Do I have to see an ‘Independent Medical Contractor’ appointed to me by a Workers’ Comp Carrier?” For some foundational information about Workers’ Compensation, check out our article: Illinois Workers’ Compensation Laws Explained.
In the state of Illinois, yes, you are obligated to receive an Independent Medical Examination (IME) from an independent medical professional to issue an unbiased opinion on your injury, if requested by your employer’s insurance company. This medical professional has to be approved by the requesting provider. While you are allowed to be treated by your own doctor, your claim is only dependent on the medical opinion of the doctor from a select list of approved providers.
Many circumstances may cause your employer’s insurance company to request an IME, and although it’s called a “request,” your claim will most likely be denied if you refuse to undergo the IME. Injured employees can expect to be scheduled for an IME when the insurance company disagrees with your personal physician’s medical opinion, your claim is moving too slowly or getting too expensive, or more evidence is needed to resolve a dispute about your claim.
What is Workers’ Compensation?
Workers’ compensation is a state-mandated insurance program that provides wage replacement and medical benefits to employees (any person who is under employment, contract for hire, or in apprenticeship, including foreign workers and minors who are lawfully or unlawfully employed, both full-time and part-time) who are injured in the course of employment in exchange for the employee’s right to sue the employer for negligence.
What Kind of Injuries does Workers’ Comp Cover?
Workers’ comp insurance is meant to cover an employee’s injuries resulting from the negligence of another employee or a company’s unlawful working conditions. The scope of covered injuries is broad, but insurance providers do set very strict limits. The state of Illinois can conduct drug and alcohol testing on the injured employee.
Can I Still Receive Medical Treatment from my Regular Doctor With Workers Comp?
While you are allowed to be treated by your preferred provider, the result of your claim depends on the professional opinion from a “neutral” doctor. If there are any disputes or questions from your employer’s insurance company, you may be required to complete a medical evaluation by a pre-approved provider of the insurance company’s choice. If you refuse or are unable to complete the IME for any reason, your claim will most likely be denied by your employer’s insurance company.
Why do I Need an IME?
If you are required to receive an Independent Medical Examination, your employer’s insurance company disagrees with your personal physician’s medical opinion, or it needs more proof of injury to approve your claim. If your claim is taking too long to process or is getting costly, the insurance company may ask for an IME to speed things up.
What Happens During an IME?
Prior to your appointment, all of your existing medical records and documents relevant to your health history or active injury report will be sent to the IME doctor. If your claim is being disputed, the insurance company may compose a letter to the doctor with specific questions and concerns about your medical condition. These questions include:
- Has your condition been correctly diagnosed?
- Did a work-related accident or exposure actually cause your current symptoms, or is it possible that you developed this condition through your personal activities and lifestyle?
- Do you need additional medical treatment or testing for your diagnosed condition? If so, what kind of treatment?
- When will you be able to return to work, if at all? Do you need restrictions on what you can and cannot do at work?
- Do you have any permanent disabilities? If so, to what extent?
If possible, you should ask to review any letters sent to the IME doctor by your employer’s insurance company to correct any factual mistakes and ensure the questions asked are relevant and appropriate. Be aware, anything you share with the IME doctor is not privileged or confidential in any way. Details of your conversation and injury will be documented and shared with the insurance company and could even be used against you at a workers’ comp hearing, if necessary.
If Approved, what Expenses does Workers’ Comp Cover?
Workers’ Compensation insurance covers medical care from the employee’s injury or illness, replacement wage (usually only ⅔ of the employee’s average wage), restraining costs, compensations for permanent injuries, and benefits to survivors of workers who are killed on the job. If an employee collects workers’ compensation benefits, he or she cannot sue the employer for negligence. Workers’ compensation insurance isn’t limited to incidental accidents, either. If an employee develops any medical problems or illnesses over a longer period of time from a work-related task or environment, they are still covered for long-term and permanent injuries.
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