If you have been injured at work and are receiving workers’ compensation benefits in Illinois, there is a good chance the insurance company will eventually ask you to attend a medical examination with a doctor of its choosing. This examination is known as a Section 12 examination, named after the provision of the Illinois Workers’ Compensation Act (820 ILCS 305/12) that authorizes it. Many injured workers refer to it as an “independent medical examination” or “IME,” although there is often nothing independent about it. Understanding your rights and obligations when it comes to a Section 12 exam is critical to protecting your workers’ compensation claim.
What Is a Section 12 Examination?
Under Section 12 of the Illinois Workers’ Compensation Act, an employer or its insurance carrier has the right to require an injured worker to submit to a physical examination by a physician of the employer’s choosing. The stated purpose of this examination is to evaluate the nature and extent of the worker’s injuries, determine whether the worker has reached maximum medical improvement (MMI), assess what medical treatment may still be necessary, and identify any work restrictions or physical limitations. In practice, insurance companies use Section 12 examinations to challenge the opinions of your treating physician, dispute the extent of your disability, or build a case for cutting off your benefits.
It is important to understand that the doctor performing a Section 12 examination is selected and paid by the insurance company. This doctor does not have a treatment relationship with you and has no obligation to act in your medical interest. The examination is typically brief — often lasting only 15 to 20 minutes — and the resulting report frequently minimizes the severity of your condition. For these reasons, experienced workers’ compensation attorneys often refer to these exams as “defense medical examinations” rather than independent ones.
Are You Required to Attend a Section 12 Examination?
Yes. Under Section 12 of the Act, you are legally required to submit to a reasonable examination when the employer requests one. If you refuse to attend without a valid reason, the Illinois Workers’ Compensation Commission has the authority to suspend your benefits until you comply. The Illinois Supreme Court confirmed in King v. Industrial Commission (2000) that an employer may require a Section 12 examination even after a permanency award has been entered, and even when the employer has not yet filed a formal petition to modify benefits.
That said, the employer’s right is not unlimited. The examination must be reasonable in scope, and the employer must provide adequate notice. If the insurance company is scheduling examinations excessively or in a manner designed to harass rather than to obtain legitimate medical information, your attorney can object and seek the Commission’s intervention.
What to Expect at a Section 12 Examination
A Section 12 examination typically involves the insurance company’s doctor reviewing your medical records, asking you questions about your injury and symptoms, and performing a physical examination. The doctor will then prepare a written report for the insurance company. You will not usually receive a copy of this report directly — your attorney will need to request it.
There are several practical things every injured worker should keep in mind before and during this examination. First, be honest and consistent. The doctor will compare what you say during the exam to what is documented in your medical records. Any inconsistencies, even minor ones, may be used against you. Second, do not exaggerate your symptoms, but do not downplay them either. Describe your pain, limitations, and daily difficulties accurately. Third, be aware that the examination may be shorter than what you are accustomed to with your treating physician. Some Section 12 doctors spend very little time with the patient before writing a report that contradicts months or years of treatment records.
How the Insurance Company Uses the Section 12 Report
The Section 12 report becomes a key piece of evidence in your case. Insurance companies commonly use these reports to argue that you have recovered enough to return to work, that you no longer need certain medical treatment, that your condition is not related to your work injury, or that your permanent disability is less severe than your treating doctor has indicated. If the Section 12 doctor’s opinions differ significantly from those of your treating physician, the Commission will need to weigh the competing medical evidence and determine which opinion is more credible.
Illinois courts have recognized that the opinions of a treating physician — a doctor who has an ongoing relationship with the patient and has provided hands-on care over time — often carry significant weight. In Bob Red Remodeling, Inc. v. Illinois Workers’ Compensation Commission (2014), the employer sought to terminate benefits after the injured worker followed the treatment recommendations of his own physicians rather than those of the company’s doctor. The appellate court ruled in the worker’s favor, holding that the relevant question was not which course of treatment was superior, but whether the claimant’s behavior was reasonable under the circumstances. The court found that his choice to follow his own qualified treating physicians was reasonable. This principle applies equally when an insurance company relies on a Section 12 examiner’s opinion to challenge your treatment: the report of a one-time examiner does not automatically override the judgment of the doctor who has been treating you.
Your Right to Choose Your Own Treating Physician
One of the most common misconceptions among injured workers is that the insurance company’s doctor is “your” doctor or that the Section 12 examination replaces your regular medical care. It does not. Under Section 8(a) of the Illinois Workers’ Compensation Act, you have the right to choose your own treating physician. The Section 12 examination is a one-time evaluation for the benefit of the employer — it is not a substitute for the ongoing medical treatment provided by your chosen doctor. You should continue following the treatment recommendations of your treating physician regardless of what the Section 12 examiner concludes. Learn more about how our workers’ compensation attorneys protect injured workers’ medical rights.
Protecting Yourself Before and After a Section 12 Examination
If you have been notified that the insurance company is scheduling a Section 12 examination, it is important to take the process seriously. Attend the appointment on time and cooperate with the examining physician. Before the exam, review your medical history with your attorney so that you are prepared to describe your symptoms and limitations accurately and consistently. After the exam, make sure your attorney obtains a copy of the Section 12 report so you can review it for any inaccuracies or mischaracterizations.
If the Section 12 doctor’s report contradicts your treating physician’s findings, your attorney can address this at hearing by presenting your treating physician’s records, testimony, or deposition to demonstrate why your doctor’s opinions should be given greater weight. The Commission regularly evaluates these competing medical opinions and has the authority to credit the treating physician over the Section 12 examiner when the evidence supports it.
If you have been injured at work and have been asked to attend a Section 12 examination, or if you believe the insurance company is using a defense medical report to unfairly reduce or deny your benefits, the attorneys at The Law Offices of Millon & Peskin, Ltd. are here to help. We represent injured workers throughout the Chicagoland area, including DuPage, Cook, Will, Kane, and Lake counties. Contact our Wheaton workers’ compensation office today at 630-449-3884 for a free consultation to discuss your case.