I was receiving treatment after I got hurt at work. Then the insurance company sent me to IME doctor. The IME doctor said I am MMI, but I am not... I'm still in pain and need more treatment or physical therapy. They are obviously trying to get out of paying for more treatment that I really need. Can I get a second opinion on the IME? If so, will the insurance company be required to pay for the second opinion on the IME?
Daniel Robert KlosowskiWorkers' Compensation LawyerAurora, IL ·
Generally, in a workers' compensation case when there is an opinion from an IME doctor saying that the client is at MMI, the response is to look to the records of your treating physicians. If your treating doctor says that you need further treatment, then an attorney can present that information to refute the opinion of the IME doctor. The attorney may need to take the deposition of the treating doctor and the IME doctor to gain a further explanation of both doctors' opinion. At this time, it would be helpful to contact an attorney if you have not already done so. The attorney can file a motion to go to trial and have an arbitrator decide whether the IME physician is correct, or if the treating doctor is correct regarding the need for further treatment.
tephen Laurence HoffmanPersonal Injury LawyerChicago, IL ·
Not really.
A Section 12, or IME exam is going to be pitted vs your doctor's testimony and the arbitrator will decide.
The IME doctor is a tool the insurer uses to combat your doctor.
If you have a lawyer, ask for explanation. If not, get one now.
You can get an IME of your own if your willing to pay for it , and they are not cheap. If you don't have a lawyer you need one other wise there is no way for you to get the insurance to do anything.
Under the Act, you have the right to 1 doctor of your choice and anyone he/she refers you to. Hopefully, you already have already seen a specialist, depending on what body part you have injured. If you have not, then I would recommend you have your treating physician refer you to a specialist who could then review the IME report and advise whether he/she disagrees with the opinion.
If you have already been seeing a specialist, then you would do as the other attorneys have suggested -that is to have your specialist review the IME report and comment on why he disagrees.
The insurance company will likely not even provide you with a copy of the IME report if you are unrepresented. If you are represented, your attorney should be able to get a copy however.
All of the above being said, the insurance company is now positioning themselves to deny your case. You truly need an attorney to help at this point. An attorney will help get a copy of the report, get it to your doctor or some other specialist, get an opinion in your favor, and then fight the case in court based upon the opinions of your doctor. This is a lot of work and most likely you will not prevail without the help of an experienced attorney. I highly recommend you seek counsel to discuss all of this.
Best of luck.
Michael Timothy MahoneyFamily Law AttorneyChillicothe, IL ·
The first thing you should do is to seek legal representation if you have not already done so. Your lawyer should be able to get an opinion from your treating physician recommending further treatment. If that does not break the deadlock you are entitled to a hearing before the worker's compensation arbitrator to resolve this issue. All other things being equal (which they rarely are) the arbitrator is entitled to afford greater weight to the treating physician's opinion.
