Why Is It Taking So Long To Get The IME Report?

When you are hurt on the job in Illinois, you generally speaking have the right to choose your own doctor.  The insurance company can’t dictate who you treat with, but does have a right to send you to a one time exam called an independent medical examination or IME.  It’s not so “independent” in many cases, as a lot of those doctors are hired guns or certainly skew toward saying what the insurance company wants them to say.

These exams can be very important to your case and it’s strongly advised that you talk to a lawyer before you go to one. What’s crazy about them is that even with a major injury, it’s not uncommon for the “exam” to last less than five minutes. A lot of the IME has to do with the doctor reviewing your medical records. The reality though is that they aren’t going to comb through thousands of pages of records. When the insurance company sets up the exam, they or their lawyer will write the doctor a letter and highlight certain records they want reviewed and often try to get the doctor to agree with their theory that the injury isn’t work related or no more treatment is needed.

With many of these doctors, they have assistants who write up a lot of their report. In most cases, they can complete a report within less than a week because a lot of it is just filling in info that isn’t unique.  It would be very unusual for it to take longer than two weeks for a report to be ready. These doctors often perform hundreds of IME’s a year and have their system down.

So why did one caller to my office tell me that it was 11 weeks since the IME and they still don’t have the report? And why wasn’t I surprised to hear that?

While most IME’s go against the injured worker, it some cases it would be impossible to do that or the doctor is just honest and tells the truth. When that happens, that report is a huge helper to the injured worker’s case and almost always kills any planned attempt to fight your case. Insurance companies are ruthless though and don’t always give up that easily. So they’ll do one of two things. First they’ll have the report and lie to you and say it’s not available. Technically they don’t have to share it with you, although we can get it usually be filing a subpoena for it. Their hope is that if they delay long enough you’ll pursue medical care through other means or return to work because you have to even though your doctor says you shouldn’t.

The second thing an insurance company might do is to tell the doctor to call them before preparing the report. If the doctor says that they are going to find against the insurance company, the insurance adjuster might say to them to not prepare a report at all.  In their minds, it cant’ be used against them if it doesn’t exist. The reality is that if the case were to go to trial and no IME report was presented, it would be inferred by the Arbitrator that it wasn’t favorable and can have the same effect as if it had been prepared.  We also could force the IME doctor to testify if we wanted to.

I’m never surprised to get this type of question because sadly it happens all of the time. The best strategy is to file a 19(b) petition for immediate hearing.  This will force the insurance company attorney to go before an Arbitrator and explain why there isn’t a report or more likely, get the insurance company to roll over since they don’t have a defense. As long as your attorney is aggressive the problem is usually solved.

If it seems to you like this is really shady, you aren’t wrong. It’s part of the game the insurance company plays.  The good news is that when the IME isn’t sent it almost always means it’s in your favor and that an experienced attorney can get the games to stop.

By Mike Helfand

Courtesy of Illinois Workers' Compensation Law Blog

Share This Article: