
A guy called our office after tearing his rotator cuff while working on a machine. He felt the injury right away, reported it right away, and went to the doctor right away. In other words, it was pretty clear that this is a compensable accident and that all of his medical bills should be paid for.
And that is how things were going, up until the point that his doctor recommended that he have surgery. At that point, the insurance company told him that he needed to attend an independent medical exam (IME) up in Chicago. That was over two hours away from his house.
Unfortunately, the insurance company is allowed to do this as long as two things are true:
- They pay your travel costs in advance, to and from the exam.
- Traveling that far will not put your health at risk.
What does not matter is the fact that there are numerous qualified doctors much closer to him that the insurance company could have sent him to.
So why would an insurance company send someone over two hours away for an exam? It doesn’t take a genius to know that the fix is in and this is a hired gun doctor.
And that is exactly what happened. From the time the doctor walked in the room to talk to him until he left was less than five minutes. He told me that this doctor asked only three questions and was mostly flipping through some papers the whole time. He abruptly said thanks and then walked out of the room. The injured worker had to ask a nurse if the exam was over and he could go.
During our call, I actually asked him to let me guess what happened. I essentially told him the story before he could tell me. He asked how I knew and it is because this type of nonsense happens all of the time. And the last thing I guessed was that the doctor said he did not need surgery and could go back to work.
No matter what this worker does next, the insurance company has obtained a victory in their minds.
Either the worker agrees he doesn’t need surgery or puts it through his own insurance. That saves them a bunch of money. Or, the worker is smart, gets a lawyer and that attorney gets the Illinois Workers’ Compensation Commission to order them to pay for the surgery. In that case they are no worse off than before, but have earned interest on money they did not spend.
And that is the big trick of insurance companies. Even if they know they have to spend a million dollars on your case, the longer they can drag out paying you or paying benefits, the more money they earn in interest. On one case that does not seem like a big deal, but over tens of thousands of cases that makes them a lot of extra money.
Of course this behavior is gross and so is the doctor who enabled them with his fake exam. But it does happen all of the time. Our recourse is to push back hard and file for penalties and fees when they have no basis for their behavior.
The shame is that this worker did not contact us before they saw the doctor as they could have been better prepared for the IME as well as this particular well known hack of a doctor. The good news is that his medical records are so clean and treating surgeon so reputable that prevailing should not be a challenge.
If you have a case you would like to discuss, please contact us any time at 312-346-5578 for a free consultation with a lawyer.







