Increased WRMEs in Oregon?
A worker requested medical exam (WRME) is the equivalent of an insurer arranged independent medical exam–but as the title implies, requested specifically by the worker.
Under ORS 656.325(1)(e), there are three main criteria when a worker can request a WRME:
- The insurer has issued a compensability denial, on which the worker has timely requested a hearing. The IME report must be based on an in-person examination, not a record review. Denise Amos, 65 Van Natta 2100, 2104 (2013);
- The compensability denial was based on at least one IME report and the claimant requests a WRME after a post-denial IME;
- The worker’s attending physician or authorized nurse practitioner does not concur with the report or reports.
OAR 436-060-0147(2)(b) provides that the director will determine a worker is eligible for a WRME if the above criteria are met and:
- The worker or insurer must provide documentation showing the attending physician or authorized nurse practitioner does not concur with the IME report or reports; or
- The director has not received documentation demonstrating whether the attending physician or authorized nurse practitioner does or does not concur with the report or reports, and at least 30 days have passed since the worker’s request for hearing.
These criteria must be satisfied at the time a claimant requests a WRME. Thomas S. Cardoza, 73 Van Natta 561, 563 (2021). For example, the Board has held where an insurer obtained a post-denial IME which supported its denial, the criteria for a WRME were not met, reasoning the denial was not based on the IME at the time claimant requested a WRME. See Julie A. Dellinger, 72 Van Natta 35 (2020).
Additionally, the Workers’ Compensation Division has authority to withdraw an initial order authorizing a WRME and reconsider eligibility if an attending physician or authorized nurse practitioner subsequently concurs with the IME report or reports within the 60-day appeal period from the initial order. See Michael R. Greco, Sr., 71 Van Natta 1405 (2019). The Board in Greco concluded claimant was no longer eligible for a WRME once the attending provider agreed with the IME report upon which the insurer based its denial. Id. at 1408.
If you receive a request for a WRME, it is important to remember some of the response deadlines are very quick. The basic process involves these steps:
- The worker submits a WRME request to WCD, copying the insurer.
- The insurer provides a list of all doctors who have treated or examined the worker to the WCD and worker within 14 days.
- The WCD will decide if a worker gets a WRME and will issue an Order that identifies the WRME doctor and instructs the worker to schedule an exam.
- The worker schedules an exam and tells the insurer when it will occur.
- The insurer must send the examiner all medical records and all questions asked of previous IME providers to WRME doctors within 14 days.
- The insurer pays the cost of the WRME.
This also means that if the insurer has a basis to object to the request, it should do so within the 14-day deadline to respond to the worker’s initial WRME request.
If you have any questions regarding worker requested medical examinations, or any other legal issues, please feel free to contact me at (503) 595-6108 or .
Posted by Evan Novotny
