Under Section 12 of the Illinois Workers' Compensation Act, an employer can require an employee receiving disability payments to be examined by a physician it selects, at its expense, to assess the nature, extent and probable duration of the injury. The examining physician writes a narrative report for the employer or insurer, which can be offered as evidence before the Commission. There is no prescribed form.
The examining physician chosen by the employer writes the whole report. The employee may have their own physician present at the exam, paid for by the employee.
The issuer sets what the letter or report must contain; check its current rules before you write it.
Section 12 medical examination report
There is no form to fill: the program asks for a letter or report with the content it sets. Vero Scribe writes the visit note it draws on, so the details are ready when you write it.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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No. IWCC's medical fee schedule FAQ says the schedule covers treatment only and does not set maximum payment for procedures performed for litigation, including an evaluative exam at the employer's request. Payment for those exams is determined between the provider and the payer.
If the employee had no physician present, Section 12 requires the examining physician to deliver an exact copy of the report given to the employer, in person or by registered mail, as soon as practicable and no later than 48 hours before the hearing. Otherwise the examiner may not testify at that hearing.
Yes. When the employer uses a Section 12 exam instead of utilization review to assess whether treatment is reasonable and necessary, the report must reach the employee or representative and the treating provider within 90 days after the employer receives the treating provider's medical records.