Is your IME Appointment Notice Compliant for the Requirements Provided for Washington Self-Insured Employers?
In recent years, the Department of Labor and Industries has increased its scrutiny of how self-insured employers schedule and send notice for Independent Medical Examinations (IMEs). Failure to follow the rules can result in cancellation of examinations, penalties, and delayed claim processing. RCW 51.36.070 outlines when the self-insured employer may be entitled to an IME examination; however, this blog post is to specifically shed light on the language/reasoning listed on the self-insured’s IME notice sent to the claimant and/or their representation.
While the latest buzz around IMEs has surrounded the rules relating to recording of examinations, it is imperative to not overlook notice requirements and ensure your IME notice is complaint with the Department’s template for IME notice language. A copy of the notice can be found here: Self-Insurance IME Assignment Letter.
First, your notice should adequately list the IME provider name, IME panel, location address, phone number, appointment date and time. The next section you will focus on is the reasoning for scheduling the examination.
For example, if you are scheduling a case progress examination, it is only appropriate to schedule this type of examination for accepted conditions and it is not sufficient to list that an examination is scheduled for “case progress” or “claim management.” Vague notices are considered non-complaint and are increasingly leading to IME cancellations. Therefore, you must clearly state why the IME is being scheduled by selecting the appropriate reasoning, including listing the appropriate accepted condition(s). It is crucial to list the appropriate accepted conditions so that the IME examiner(s) have the correct information when performing their examination.
To be considered fully complaint with the notice requirements, you must then list the companion, recording language and dispute language also provided on the Department form.
As an additional reminder, it is also crucial that IME notice is sent timely pursuant to WAC 296-15-440 (b). Notice of the IME should be mailed to the claimant and their representative no later than 28 calendar days prior to the IME. Except for an IME scheduled to make a decision regarding claim allowance, then the requirement is 14 days’ notice in that scenario. Please note, the claimant does have the right to waive these notification requirements; however, ensure that the claim file is thoroughly documented with this information if you have a discussion regarding waiver of notice.
Pursuant to Department policies, if L&I makes the determination that the IME does not comply with the rules a day before the IME is scheduled to occur, the Department will not reimburse the employer for the late cancellation fee.
Our office is able to help you navigate notice requirements and ensure your IME notice is compliant to avoid claim processing delays, late cancel IME fees and/or penalties. Please do not hesitate to contact Allison at (503) 595-6106 or to discuss IME notice requirements.
Posted by Allison Harper.
