Who Controls Return-to-Work Decisions in Washington?
Independent medical examinations (IMEs) are an important tool in Washington workers’ compensation claims. IME physicians can provide opinions regarding diagnosis, causation, treatment recommendations, maximum medical improvement, and work restrictions. However, one of the more common return-to-work disputes arises when an IME examiner believes a worker can return to light-duty work, but the attending provider disagrees. In those situations, employers and claims administrators often ask whether they can rely on the IME opinion to offer work or terminate time-loss compensation. The answer is often more complicated than it appears.
Under RCW 51.32.090(4)(b), an employer may offer a worker light-duty or transitional work while the worker is recovering from an industrial injury. To do so, the employer must provide the attending provider with a description of the available position so the provider can determine whether the worker is physically capable of performing that job. The worker must also receive a copy of the job description.
The attending provider then determines whether the worker is able to perform the specific position being offered. Time-loss compensation generally continues until the worker is released by the attending provider for the offered work and begins performing it.
This process can create potential confusion when an IME examiner reaches a different conclusion regarding work capacity. For example, an IME examiner may determine that a worker can perform a receptionist position with occasional lifting of up to 20 pounds. However, if the attending provider has only approved sedentary work with no lifting, the employer should not assume that the IME alone authorizes the worker to perform the receptionist position or permits termination of time-loss compensation.
Instead, the employer should provide the attending provider with a detailed job analysis and request an opinion regarding whether the worker can perform that specific job. If the attending provider does not approve the position, the employer should clarify whether the provider is rejecting the job entirely, objecting to a particular duty, or imposing additional restrictions. In some cases, the disagreement may be resolved by modifying the job duties or providing accommodation.
The disagreement may also raise other claim administration issues. Employers and claims administrators should consider whether the worker qualifies for loss of earning power (LEP) benefits.
Under RCW 51.32.090(3), LEP benefits are generally available when a worker’s earning power has been reduced by more than 5 percent because of an industrial injury or occupational disease. Accordingly, if a worker is capable of performing approved light-duty work but earns less than they did at the time of injury, payment of time-loss benefits is no longer appropriate. However, the worker may still qualify for LEP benefits if the statutory requirements are met.
Ultimately, an IME can provide valuable information regarding a worker’s functional abilities, but it does not automatically replace the attending provider’s role in approving a specific light-duty job under RCW 51.32.090(4)(b). When opinions conflict, the safest approach is to obtain a clear response to a detailed job analysis, document the disagreement, and evaluate whether the next step should involve job modification, additional medical clarification, vocational services, LEP benefits, or a determination by the Department.
If you have questions about return-to-work issues in Washington workers’ compensation claims, please do not hesitate to contact our office. You can contact me at (503) 595-6112 or .
Posted by Naomi Kitchen-Huan.
