What Insurance Companies and Employers May not Want You to Know

la clinica what insurance companies and employers may not want you to know

What Insurance Companies and Employers May not Want You to Know

La Clinica SC of Cicero once again held a free community workshop with medical and legal experts to answer your questions about the healing process and your legal rights when injured.

Dr. Eugene Jao of La Clinica SC and a worker’s compensation attorney were on hand once again to speak about the healing process and your legal rights when injured. A Q&A with the experts followed the presentations with a special focus on what you should know when working with employers and insurance companies regarding your injury care. Here are just a few of the questions that were asked:

What is an IME (Independent Medical Exam) and why do insurance companies require it? 

The IME (Independent Medical Exam) is an examination that can be conducted to determine the cause, extent and medical treatment of a work-related or other injury where liability is at issue. It is also used to determine whether an individual has reached maximum benefit from treatment; and whether any permanent impairment remains after treatment. Workers’ compensation insurance carriers, auto insurance carriers, and self-insured employers have a legal right to request an IME. 

What if the IME doctor enlisted by my employer or by the insurance company does not agree with my own doctor?

If you (the patient) have your own doctor, the opinion of the IME doctor may be disputed by your doctor and your doctor should provide documentation and testing that supports his opinion. 

Example: Your doctor determined that there is a need for a surgery but the IME doctor determines that there is no need for surgery. In that scenario the dispute will be settled in court. It is important to have on your side an attorney and a doctor experienced in these matters.

What are my rights when it comes to receiving compensation for my employment disability or suffering?

The insurance company or employers are not likely to discuss disabilityor pain compensation with employees. Many injured workers who do not have an attorney to represent them settle their cases without receiving full compensation. All employment disability issues should be handled by an experienced Worker’s Compensation attorney because there are many factors that go into the amount calculations and they can help you get everything that you are entitled to. 

If you need help finding an attorney who specializes in Workers’ Compensation Law, please contact our staff and we will be happy to refer you to the appropriate specialist. You can also attend one of our free monthly workshops where specialists will be available to answer your questions.

My employer is telling me to go to their doctor but I would like to see my own doctor. What can I do?

Employers and insurance companies have a network of doctors that they work with and send their injured workers to. As an injured worker in Illinois, you have the right to find your own doctor and manage your own work injury care.

There are legalities involved and in order for you to manage your own care, it is helpful to retain an attorney. Many employers and insurance companies will not encourage or mention the right for you to have an attorney.

What is the benefit of finding my own doctor instead of the doctor that the company sent me to?

Finding a doctor that is not part of the company’s network is a good idea when you feel that the company doctor has not helped enough or is not looking out for your best interests. Remember that the doctor that is independent from the company has no affiliations with the insurance or your employer. In many occasions, your own doctor can order diagnostic testing and care without the approval of the insurance or company.

NOTE: It is important to find a doctor that has experience in injuries and in the Worker’s Compensation guidelines for Illinois or the state where the injury occurred. The doctors at La Clinica SC have many years of experience with injury cases involving worker’s compensation.

If you have further questions regarding your right to see your own doctor or any other injury-related question, please contact our staff or attend our next free monthly workshop where medical and legal experts will be available to speak to you and answer your questions in both Spanish and English.

Legal Disclaimer

This website provides information about the law designed to help our visitors with their own legal needs. However, legal information is not the same as legal advice. Although we do our best to ensure that our information is accurate and useful, we recommend that you consult a lawyer if you want professional assurance that our information, and your interpretation of it, is appropriate to your particular situation. If you need assistance finding an attorney, our staff will be glad to refer you to an attorney that can help.