What's New in Claims

New independent medical examination rules take effect July 23, 2023

Recent Legislation under SHB 1068, which passed during the 2022-2023 session, made some changes to the independent medical exam process. These changes take effect on July 23, 2023.

Independent Medical Examination-Recording

  • You may record your independent medical examination using audio, video, or both. Here is some information to keep in mind should you elect to record your examination:
    You or your representative must provide notice to the IME provider that you intend to record the examination no less than seven calendar days prior to the examination.
  • You are responsible for any costs associated with recording.
  • You may not hold the recording equipment while the examination is occurring. (Note: If you’re going to use your mobile phone, you must select record and then set it down).
  • You must take reasonable steps to ensure the recording equipment does not interfere with the examination.
  • Upon request, you must provide one copy of the recording to L&I or your self-insured employer within 14 days of receiving the request. You are not obligated to send the recording until the written report has been issued. Recordings should only be sent to L&I, when requested.
  • You may not materially alter the recording (edit the material in any way). Benefits received because of any alteration of the recording by you or done on your behalf may be subject to repayment pursuant to RCW 51.32.240.
  • You may not post the recording to social media.
  • Records are deemed confidential pursuant to RCW 51.28.070.

Independent Medical Examination-Companion

You have the right to have one person present at the examination.

Here is some information regarding the companion:

  • The companion must be at least 18 years old.
  • They must be unobtrusive and not interfere with the examination.
  • The companion may not be the workers legal representative or an employee of the legal representative.
  • The companion may not be the attending provider or an employee of the attending provider.

We have answers to the most frequently asked questions (FAQs) and invite you to learn more.

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Independent medical examination rules took effect April 23, 2022

New Washington Administrative Code (WAC) rules that set guidelines for independent medical examinations (IME) take effect on April 23, 2022.

The rules were created and/or updated to support ESSB 6440, passed during the 2019-2020 legislative session.

ESSB 6440 amended RCW 51.36.070. The new state law sets parameters for when an independent medical examination can be requested, states that examinations must be scheduled in reasonably convenient locations, and establishes telemedicine as an option for IMEs.

The new rules, and their highlights, include:

WAC 296-23-302, “Definitions.”

  • Updated to include a definition of case progress examination.

WAC 296-23-308, “Scheduling case progress examinations.”

  • Establishes thresholds that must be met in order for a case progress IME to be appropriate:
  • Time (120 days from receipt of claim) or last case progress IME.
  • Requirements related to consultations and requests of the attending provider.

WAC 296-23-309, “How many examinations may be requested?”

  • Establishes criteria for the total number of examinations per claim.

WAC 296-23-401, “Can the department schedule an examination or order a self-insured employer to schedule an examination after receipt of an appeal to the board of industrial insurance appeals (BIIA)?"

  • States that the department can reassume following receipt of an appeal and direct a self-insured employer to schedule an IME.
  • Copies of the rules can be found at 2114 Adoption (wa.gov) and 2128 Adoption (wa.gov).
  • Updates to the Claim Adjudication Guidelines will be available April 22, 2022.

WAC 296-23-403, “Independent medical examinations—Department data reporting.”

  • Explains that the department will regularly provide independent medical examination data.

WAC 296-15-440, “Use of independent medical examinations. What will the department consider when resolving a dispute to a scheduled independent medical exam (IME) in a self-insured claim?”

  • Details what the department needs to receive when an IME is disputed.
  • The dispute should state the specific reason(s) why the worker or provider feels the IME is not appropriate.
  • Establishes timeframes associated with the resolution of IME disputes.
  • Explains how the department will resolve IME disputes.

WAC 296-15-440 is effective April 23, 2022 for IMEs scheduled after that date.

L&I Updates Independent Medical Exams Criteria

(updated 2/28/2021)

Engrossed substitute senate bill 6440 amended requirements for Independent Medical Examinations (IMEs) for worker compensation claims by the Department of Labor & Industries (L&I). These changes affected employers who purchase workers’ compensation coverage from the department (the “State Fund”) as well as those that are self-insured.

The passing of ESSB 6440 amends requirements for independent medical exams IMEs within the workers’ compensation system and creates a multi-disciplinary workgroup, led by L&I, to recommend innovations to the legislature that improve the IME process. This bill takes steps to address concerns with IMEs by:

  • Identifying specific reasons for how, when, and where an IME can be requested
  • Introducing telemedicine as an option to reduce burden to workers
  • Limiting the ability to assess a no-show fee

Before this new law, an IME could be scheduled “Whenever the director or the self-insurer deemed it necessary.” This new law further clarifies when an IME can be requested.