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In December of 2024, the Board adopted a new procedure to expedite decisions on causally related and consequential injuries. When 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 issue a Proposed Decision finding PFME, and will afford the insurer the right to accept the condition, get an independent medical examination (IME), cross-examine the health care provider, or make an argument on the record.
However, stakeholders have requested a more concrete ability to develop the record on mechanism of injury. In revisiting this process, stakeholders can now expect the following:
- Once the Board issues the PFME Proposed Decision, it will set the case for a hearing approximately 75 days later.
- At that hearing, the insurer must produce the evidence directed by the Proposed Decision. In addition, the parties will have the opportunity to take brief testimony of the claimant on mechanism of injury.
- If an IME does not contest the injury or condition, the judge will make a decision on the additional site at this first hearing.
- If the IME finds that the injury is not related, and depositions are requested, the judge will grant a continuance for outcome of those depositions.
It is expected, absent good cause, that the Board will resolve these issues within one to two hearings.
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 a waiver of the right to get an IME or cross-examine claimant’s provider. In addition, to be considered timely, any requests for a broader release of medical records should be made well in advance of the scheduled hearing.
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