Workers Compensation Case? How Does A Work Injury Case Work?

Independent Medical Exams: What They Really Are and How to Prepare

At some point during your workers comp case, the insurance company is going to send you to a doctor for what they call an Independent Medical Examination. Let me be clear about something upfront. There is nothing independent about it. The IME doctor was chosen by the insurance company, is being paid by the insurance company, and has a financial incentive to give the insurance company the answer they want.

Here is how it works. The insurance company selects a doctor, usually someone who does a high volume of IMEs and has a track record of producing reports favorable to insurers. They send the doctor your medical records along with specific questions they want answered. Those questions are designed to elicit specific answers. Is the injury related to work? Has the claimant reached maximum medical improvement? Can the claimant return to work? The doctor examines you for fifteen or twenty minutes, reviews the records the insurer chose to send, and writes a report.

I have read thousands of these reports. The pattern is always the same. The IME doctor finds that your injury is not as severe as your treating doctor believes. Or that you have reached maximum medical improvement when your treating doctor says you have not. Or that you can return to full-duty work when your treating doctor says you still have restrictions. The report is written in clinical language that sounds objective, but the conclusions consistently favor the insurance company.

Here is how to prepare. First, be honest. Do not exaggerate your symptoms and do not minimize them. Answer questions accurately. If something hurts, say so. If you can do something but it causes pain, explain that clearly. The IME doctor is looking for inconsistencies between what you say and what they observe, and any inconsistency will end up in the report.

Second, do not volunteer information. Answer the questions the doctor asks and nothing more. Do not tell stories. Do not explain your whole medical history. Do not talk about your case or your lawyer. Just answer the specific question that was asked.

Third, keep track of time. Note what time you arrived, what time the examination actually started, and what time it ended. Many IME exams last fifteen to twenty minutes, which is not enough time for a thorough evaluation. If the doctor spent ten minutes with you and then wrote a twenty-page report, that discrepancy matters at arbitration.

Fourth, bring someone with you if possible. Under Illinois law, you have the right to have a representative present at the IME. This is usually a nurse or paralegal from your lawyer's office. Their presence keeps the doctor honest and creates an independent record of what was said and done during the examination.

The most important thing to understand is that the IME is not the final word. At arbitration, the arbitrator hears from both your treating doctor and the IME doctor. Your treating physician has been monitoring your condition over months or years and has an ongoing therapeutic relationship with you. The IME doctor saw you once for fifteen minutes. In my experience, arbitrators give significantly more weight to the treating physician's opinion, especially when the IME was clearly a hired gun.

If you have an IME coming up and you are nervous about it, call me at 312-500-4500. I will walk you through exactly what to expect.

An Administrative Process

There’s some confusion about how these cases work, but most of them follow a uniform process. 

The Illinois Workers’ Compensation Commission sets the procedure, which starts with the employee or employer filing a claim. And you can learn more straight from the source on their website.  There are guides and rules and a very good Q&A section.  It is written so that average folks can read it and understand how it works, but some if it is a little complicated.  You can find that link here.

A workers’ compensation case starts with by filing an Application for Adjustment of Claim at the Commission.  This costs nothing.  Also, if a lawyer represents you, they have to file the Attorney Client Agreement.  The attorney fee in Workers Comp is usually 20%, unless there is already a written offer on your case.  A Chicago personal injury lawyer can help you prepare these documents correctly.

Accepted or Disputed?

If the Workers Comp insurance held by your employer agrees that you were hurt and is paying for your medical bills and time off work, then lawyers cann this an "Accepted" case.  Just be aware that just because a case is "Accepted" right now does NOT mean that they will not change their mind in the future.  

That can include an imaginary or frivolous reason for ending your beenefits nad paymens, even if you did nothing wrong.  I see it all the time in the typical Workers Compensation case. Just because they are paying now doesn't mean they aren't setting you up to defeat your claim.

When there’s a Disputed claim, first a hearing is requested by the employee or employer.The Arbitrator assigned to hear the case  has a Calendar, and the lawyer requesting the hearing has to pick a date that is good for the Arbitrator or Judge. Not much can happen until the patient has been diagnosed. 

Doctors Matter

Doctors really do control how an Arbitrator evaluates a case.  That’s why it is important to have a good doctor who is on your side.

Only a doctor is allowed to give an opinion on the following:

• Whether you can go back to work.
• If you can return to do your old job.
• Whether you need medical care.
• If  your injuries are permanent.
• what percentage disability you have.
• whether medical care is appropriate and necessary.

As you can see, these are important aspects of a Workers Compensation case.  That's why you must have a doictor on your side if you got hurt at work.  Using the Company Doctor is not a good idea.

The Litigation Process

While the case is in arbitration, hearings will be scheduled on a rotating basis every three months.  If the case is less than 3 years old, it is considered “below the line” — which means that the case is not immediately set for trial while parties gather evidence and the injured worker heals and gets necessary medical care.

Until the case is resolved, or moves to trial, there will be a status call every three months on the case. After three years, the case is automatically considered ready to try or to be resolved.  If lawyers do not attend the call, the case could be dismissed.

Workers Comp trials are less involved than ‘third party’ cases which are tried before a Judge and Jury.  Workers Comp trials are more streamlined and some can be over in 20 minutes.

After the trial, a decision is issued within 60 days. The Illinois Workers’ Compensation Commission handbook notes that by the time a hearing goes to trial it is normal for one to two years to have passed.

Frequently Asked Questions: 

What are the steps in an Illinois workers compensation case?

The basic sequence: you get hurt at work, report it to your employer, get medical treatment authorized by the insurance company, receive TTD benefits while you can't work, reach maximum medical improvement, get a permanency rating, and then negotiate a settlement. If the insurance company denies benefits or disputes value, a petition for hearing is filed with the IWCC and the case goes to arbitration. Many cases settle before arbitration. The whole process typically takes one to three years.

Does it matter if my injury was partly my own fault at work?

No — workers compensation in Illinois is a no-fault system. You can recover workers comp benefits even if you were partially or fully responsible for the accident, with only a few exceptions. This is one of the most important features of workers comp — you don't need to prove anyone was negligent, only that the injury occurred at work.

Can my employer fire me for filing a workers comp case in Illinois?

Firing an employee in retaliation for filing a workers comp claim is illegal in Illinois and constitutes retaliatory discharge. If you are fired, demoted, or treated adversely because you filed a workers comp claim, you may have a separate civil lawsuit for retaliatory discharge in addition to your workers comp case. If this happens to you, call me immediately at 312-500-4500.

What if my employer doesn't have workers comp insurance in Illinois?

Illinois law requires virtually all employers to carry workers comp insurance. If your employer is uninsured, you can still bring a claim through the IWCC — the Commission has an Uninsured Employers Fund for exactly this situation. The employer also faces significant criminal and civil penalties for failing to carry insurance. Being uninsured does not eliminate your right to benefits.

Protect Your Rights

Would you like to know more about how workers compensation cases work? 

If you or a loved one is dealing with a situation like this, give us a call any time, day or night.  We are here to help. 312-500-4500

>> Go To Main Topic Page