Have you or someone you know been negatively affected by the new Washington IME rules? Get help here!
The new Washington Independent Medical Exam (IME) recording and co-recording rules have made obtaining an IME even more difficult than when they were limited by WAC 296-23-309 last year. Here are some alternative options if you can’t get an IME under WAC 296-23-309 or if you can’t find a medical provider in a reasonably convenient location who will allow IME recording under RCW 51.36.070.
Option 1: Medical Record Review. A medical record review—alternatively known as a forensic IME—is when a selected medical provider reviews the claimant’s medical records and answers questions provided in a cover letter. There is no physical examination, which can serve as a limitation on what conclusions a doctor can provide in response to a Record Review. One positive, however, is there are no limitations on forensic record reviews. Under the Department of Labor & Industries guidelines, a record review does not count towards the limitations on the number of IMEs under a claim because the worker is not submitting to the examination. Additionally, surveillance footage and vocational records can also be provided as part of the forensic review. Finally, a forensic review is often less expensive than a normal IME with a physical examination. Situations when a forensic IME could be beneficial are when there is a discrepancy in claimant’s self-reported abilities that do not conform to surveillance, or if there is a well-documented history of a pre-existing condition.
To request a record review, you can contact an IME company, or any other qualified medical expert, and request a forensic record review. Typically, this involves filling out a form and requesting a record review. You can request a specific doctor and include all the reasons for the review or all the issues you are faced as a claim examiner.
Option 2: Functional capacity exam (FCE) or physical capacity exam (PCE). A functional capacity exam is when a Department of Labor & Industries approved medical provider tests a claimant’s physical abilities through a series of tests. The examiner then determines work restrictions and evaluates whether claimant is capable of performing up to five jobs from the job analyses. The exam usually takes around 3-6 hours to complete. A functional capacity exam is typically requested by claimant’s attending provider or a vocational counselor when it is determined that a claimant can return to some kind of work. However, the exam can also be requested by an employer or third-party administrator on behalf of an employer.
One potential issue with an FCE is that the provider does not typically review medical records, so the exam is all they have to go off of in order to make their determination. If there are concerns that the claimant may exaggerate or misrepresent abilities, an FCE’s findings may not be valid. There are limits to how many FCEs a claimant can have, which is one every six months unless there has been a change in their medical condition. While an FCE can be useful in assessing whether a claimant can return to full or modified duty, it does not assess issues of causation, medical treatment, or permanent impairment.
Overall, an IME is generally preferred for a comprehensive analysis of medical records and an independent physical examination when there are complex medical histories or contradictory medical records/exam findings. Given the ongoing difficulties with scheduling IMEs due to the new legislation, employers can consider an FCE or a record review/forensic IME as beneficial alternatives.
If you have any questions about the new Washington IME recording rules, please contact me at 503-776-5416 or .
Posted by Sara Densmore.
