In December of 2024, the Board will use a new procedure to expedite claims for additional sites of injury and consequential injuries. Going forward, if the Board receives a Request for Further Action by Legal Counsel (Form RFA-1LC) presenting prima facie medical evidence (PFME) for an unestablished injury or condition, the Board will expedite a determination by issuing a Proposed Decision finding PFME.
Unless the insurer contends that the finding of PFME was made in error, there should be no objection to the Proposed Decision. Rather, within 30 days of the Proposed Decision, the insurer should proceed as follows:
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If the insurer accepts the new body part or condition, it should notify the Board by filing a FROI-02.
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If the insurer does not accept the new body part of condition, it should proceed with development of the record by either:
- Obtaining an independent medical examination (IME) within 60 days; or
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Waiving the IME and cross-examining the claimant’s health care provider within 60 days.
Note: A Claimant's Notice of Independent Medical Examination (Form IME-5) or proof of a testimony date must be in the file by the date the Proposed Decision becomes final, or the Board may deem the insurer’s inaction as acceptance and the site may be established.
Once the Proposed Decision is finalized, the Board will determine next steps, which may include:
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A Proposed Decision establishing the injury/condition
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A Reserved Decision (if the record is complete)
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A Proposed Decision directing depositions (if there is a joined issue)
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A hearing for additional development of the record and a bench decision
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