New L&I Rules Regarding IMEs Take Effect April 23, 2022
Starting April 23, 2022 the Washington Department of Labor & Industries will be implementing new rules regarding IME notices and what constitutes a “case progress examination.” The rules also create a process for a worker to dispute whether they should be required to attend an IME.
Under the new rules notice of an IME must be mailed to the worker 28 calendar days before an examination. Notice should include an explanation of the need for an exam and how it can be disputed by the worker. WAC 296-15-440.
Exams can continue to be scheduled to make a determination regarding compensability of a claim or reopening application, determine the extent of permanent partial disability, and evaluate case progress. RCW 51.63.070. However, the new rules clarify the meaning of “case progress” and when it is appropriate to schedule an IME for this reason.
Case progress examinations can be scheduled when a necessary and proper treatment plan is not in place, or the treatment plan has stalled/been completed without resulting improvement in the worker’s condition. WAC 296-23-302. Case progress examinations cannot be scheduled until at least 120 days have passed from receipt of the claim or the last case progress exam, unless otherwise requested by the attending provider. WAC 296-23-308.
Injured workers can contest the necessity of an IME by filing a dispute with the Department or employer. In the event the dispute is filed with the employer it should be forwarded to the Department within 5 working days of receipt. In certain situations, the Department may postpone an IME pending a determination regarding its necessity. However, if a worker attends a disputed IME which is later determined to be unnecessary that report cannot be used in administration of the claim. WAC 296-15-440.
Ultimately the new rules make scheduling an IME a little more difficult. However, they can also be used as a tool to hold treating providers accountable when it comes to implementing a treatment plan. With that in mind, keep these rules in mind when scheduling an exam otherwise you run the risk of getting a great report that cannot be used to process the claim.
Have question about the Department’s new rules? Feel free to contact me at (503) 595-6110 or .
Posted by: David White