You have been injured at work. Your employer is paying your medical bills. Your doctor has taken you off of work, and you are receiving your TTD (Temporary Total Disability) payments regularly and on-time. Your case is moving along fine, but your pain is not improving, and now your doctor wants you to have surgery. You then receive a letter from your employer’s Workers Compensation insurance carrier, and they are requesting you to drive 150 miles to see a doctor you have never been to before. They are also telling you that until this examination is complete and they have received the findings from the doctor, they are not willing to authorize the recommended surgery.
This examination they are requesting you to attend is referred to as the Section 12 examination. It is more informally referred to as the Independent Medical Examination (IME). It receives its name based on the Section under the Illinois Workers Compensation Act (the Act) which grants its authority. Section 12 of the Act provides in pertinent part:
“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 selected by the employer, at any time and place reasonably convenient for the employee, either within or without the State of Illinois, for the purpose of determining the nature, extent and probable duration of the injury received by the employee, and for the purpose of ascertaining the amount of compensation which may be due the employee from time to time for disability according to the provisions of this Act.”
In short, as long as you are entitled to benefits under the Act, your employer provides you with travel expenses, and the physician they would like you to see is not unreasonably far away, they have the right to have a doctor of their choice examine you to see if his opinion of your injury, recommended treatment, and connection to your work-accident aligns with that of your treating physician. If it does not, either in part or in whole, they potentially have, at least temporarily, the legal justification for suspending all or some of your benefits.
What happens if you don’t attend the scheduled appointment? The Act further states…
“If the employee refuses to submit himself to examination or unnecessarily obstructs the same, his right to compensation payments shall be temporarily suspended until such examination shall have taken place, and no compensation shall be payable under this Act for such period.”
If you read this paragraph carefully, you will note that benefits are to be suspended if you refuse to submit yourself to the examination or unnecessarily obstruct the same. If you are searching for excuses to avoid attending the appointment, you can expect your benefits to be suspended, and rightfully so. You should do everything in your power to attend this appointment. However, sometimes life comes at you fast and you find yourself in an unavoidable situation. If you are facing a family emergency or are too ill to attend, you should contact the adjuster assigned to your claim immediately and should be prepared to support your basis for cancellation with evidence. Try to give as much notice as possible. The more notice you are able to provide, the more understanding he/she will be. Bear in mind that last-minute cancellations may and usually do result in a cancellation fee for the insurance company. As such, they tend to lack mercy when it comes to changing these appointments. If your basis for being unable to attend is flimsy or avoidable, such as lack of transportation, conflicting appointment, etc., rest assured your benefits will be suspended, and will probably be upheld by the Arbitrator. Ample notice of these appointments is generally given, along with travel expenses.
If you find yourself in the above-described situation and are unable to maintain your Section 12 examination, for whatever reason, please contact our office immediately for assistance.