Updated October 2026 to reflect Public Act 104-0792 (HB 5228), which amended Section 12 of the Illinois Workers’ Compensation Act effective August 7, 2026.
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 call it an “independent medical examination” or “IME,” although the doctor is chosen and paid by the employer. Section 12 was amended in August 2026, and the change affects what happens when an insurance company uses one of these exams to deny your treatment.
What Is a Section 12 Examination?
Under Section 12, the employer or its insurance carrier may require an injured worker who is entitled to disability payments to be examined by a qualified medical practitioner of the employer’s choosing. The employer pays for the exam, and it must be held at a time and place reasonably convenient for you. The statute describes its purpose as determining the nature, extent, and probable duration of the injury and the amount of compensation due. In practice, insurance companies use these exams to challenge your treating physician, argue that you have reached maximum medical improvement (MMI, the point at which your condition has stabilized), dispute your work restrictions, or build a case for cutting off benefits.
The examiner is selected and paid by the employer or its insurance company and has no treatment relationship with you, so the examiner’s opinion may differ from your treating doctor’s. Those differences are often what a dispute over benefits turns on.
Are You Required to Attend, and What Must the Insurance Company Provide?
Yes, you generally must attend. If you refuse or unnecessarily obstruct the exam, Section 12 provides that your right to compensation payments is suspended until the exam takes place. In King v. Industrial Commission (2000), the Illinois Supreme Court confirmed that an employer may require an exam after a permanent total disability award to evaluate whether that award should be modified.
The employer’s right comes with obligations. Under the Commission’s rules, you need not attend unless you receive the name and address of the examining doctor in writing when the exam is requested. If you live in Illinois, the employer must deliver enough money to cover your travel and necessary meals along with the notice of the exam, and it must reimburse wages you lose because of the exam. You also have the right to have a qualified doctor of your own choosing present, at your expense. If you do not receive the travel money, tell your attorney immediately instead of skipping the exam on your own, because a missed exam can be used to argue that your benefits should be suspended.
You Are Entitled to the Examiner’s Report
Section 12 requires an examiner who is hired by the employer, when you have no doctor present at the exam, to deliver to you or your attorney a written statement of your condition that is an exact copy of what the examiner gives the employer. It must be delivered as soon as practicable and no later than 48 hours before the case is set for hearing. If the examiner refuses to provide it, that examiner is not permitted to testify at the next hearing.
What Is New: The 2026 Amendment to Section 12
Before August 2026, Section 12 spoke only of exams to determine the nature, extent, and duration of an injury and the compensation owed. Insurance companies nevertheless used Section 12 doctors to say that treatment recommended by your own doctor was not reasonable or necessary, and then relied on that opinion to refuse to authorize or pay for care, often with no deadline for getting the exam done.
Public Act 104-0792 addresses that practice. When an employer asks a doctor to examine the reasonableness and necessity of medical services under Section 8(a), instead of using a utilization review under Section 8.7, the amended statute now requires the following:
First, the exam and the report must be provided to you or your representative and to your treating health care professional within 90 days after the employer receives your treating provider’s medical records requesting the service. The employer must exercise due diligence in requesting and collecting those records.
Second, the examining doctor must be board certified in the same specialty as your treating provider.
Third, if the employer fails to comply with these requirements after receiving the specified medical records, the amendment creates a rebuttable presumption that the employer is responsible for attorney’s fees and costs under Section 16 and additional compensation under Section 19(l). The employer may present evidence to rebut that presumption. It applies to failures to authorize or approve treatment as well as failures to pay for treatment. Learn more in our post on penalties when the insurance company delays your benefits.
What the Amendment Does Not Change
The new requirements are directed at examinations of the reasonableness and necessity of treatment that the employer uses instead of a utilization review. The text does not set a 90-day deadline or a same-specialty requirement for an exam that addresses only other questions, such as whether your injury was caused by work, whether you have reached MMI, or what your work restrictions are. An exam that covers several of these issues, including treatment, requires closer analysis, and this is a cautious reading of the statute rather than a settled court holding. A late report also does not automatically make your treatment approved. The amendment does not expressly explain how its requirements apply to treatment requests or examinations that were already pending on its effective date, and it does not limit the change to accidents on or after that date. An attorney can evaluate how it applies to your facts.
How the Insurance Company Uses the Report and How It Is Weighed
The Section 12 report becomes a key piece of evidence. When the examiner’s opinions differ from your treating physician’s, the Commission decides which opinion is more credible. The Illinois Supreme Court has held that the Commission may give greater weight to a treating physician, and it has also held that the Commission may credit the employer’s examiner instead. Either result depends on the evidence, including what records the examiner reviewed and how well the opinion fits the facts of your job and injury. In Bob Red Remodeling, Inc. v. Illinois Workers’ Compensation Commission (2014), the Appellate Court, Workers’ Compensation Commission Division, found that a worker who followed his own treating physicians’ recommendations acted reasonably on the facts of that case. That decision does not give you a right to disregard the employer’s doctor, which is one more reason to talk with your attorney before making treatment decisions after an exam.
Your Right to Choose Your Own Treating Physician
A Section 12 examination does not replace your regular medical care. Under Section 8(a), you have the right to choose your own treating physician. The exam is an evaluation requested by the employer, and it does not make that doctor your treating physician. You should keep following your treating doctor’s recommendations. See also our post on your right to choose your own doctor.
Protecting Yourself Before and After a Section 12 Examination
Attend on time, be honest and consistent, and describe your symptoms and limitations accurately without exaggerating or downplaying them. Review your medical history with your attorney beforehand. Then tell your attorney as soon as the insurance company denies or delays any treatment your doctor has recommended, and keep copies of the denial and the date your doctor’s office sent its records. Those dates may determine whether the 90-day period was met. When the insurance company names an examiner, your attorney can check whether that doctor is board certified in the same specialty as your treating provider. For more on this situation, read what to do when the insurance company denies your doctor’s recommended treatment.
Quick answer: Do I have to go to the insurance company’s doctor (IME)? See this and other common Illinois workers’ compensation questions answered in one place.
If you have been injured at work and have been asked to attend a Section 12 examination, or if the insurance company is using a defense medical report to deny your treatment or reduce 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 630-260-1130 for a free consultation to discuss your case.
This article is general information, not legal advice. Last updated October 2026.