What's New in Claims
New independent medical examination rules take effect April 23
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
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. We have answers to the most frequently asked questions (FAQs) and invite you to learn more.