If you are recovering from a workplace injury in Illinois, your employer or their insurance carrier may request that you undergo an Independent Medical Examination, commonly called an IME. Despite the neutral name, this examination is arranged by the insurance company to evaluate, and sometimes challenge, your workers’ compensation benefits. Recent legislative changes under House Bill 5228 have added new rules that strengthen worker protections during this process. However, this is still pending the governor’s signature, so it is not final yet.
New statutory rules under Section 12 of the Illinois Workers’ Compensation Act
Under Section 12 of the Illinois Workers’ Compensation Act, employers have the right to require an injured worker to submit to an examination by a physician of their choosing. House Bill 5228 introduced several important requirements that now govern this process for IMEs addressing the reasonableness and necessity of medical care:
- The examining physician must be board-certified in the same specialty as the treating healthcare professional who is requesting approval for the recommended care
- The 90-day clock begins when the employer receives the medical records from the treating healthcare provider, not from the date of the exam itself
- Within that 90-day window, the physician must deliver the report to the employee, the employee’s legal representative, and the employee’s treating healthcare professionals
- If the employer fails to meet the board certification requirement or the 90-day deadline, Illinois law creates a rebuttable presumption that the employer is responsible for additional compensation under the Section 16 and 19 penalty provisions of the Act
- Under the revised statute, a Section 12 IME report is no longer considered a valid form of utilization review
It is worth noting that the 90-day requirement applies specifically to IMEs involving reasonableness and necessity of care. IMEs ordered at the end of a claim to address disability ratings or return to work function at maximum medical improvement are not subject to the same deadline under the current reading of the statute.
How to protect yourself during an IME
How you prepare for and conduct yourself during the examination can affect your claim:
- Be honest and consistent: describe your symptoms, pain levels, and physical limitations accurately, without exaggerating or minimizing
- Review your medical history: go over your accident details and treatment history before the exam so your answers align with your treating physician’s notes
- Assume you are being observed: IME physicians and insurance representatives may evaluate your mobility from the moment you arrive until you leave
- Take notes immediately after: record the length of the exam, the questions asked, and any physical tests performed while the details are fresh
Documenting your experience creates a record you can share with your attorney if the report later misrepresents what occurred.
Before you attend
An IME can have a direct impact on your benefits, and the rules governing the process have recently changed in meaningful ways. If your employer has requested one, speaking with an Illinois workers’ compensation attorney before the examination can help you understand what to expect and how to respond if the results are used against your claim.