Scheduling Independent Medical Examinations: A few reminders
In January 2021, updates to RCW 51.36.070 placed restrictions on when an Independent Medical Examination (IME) may be scheduled. We were recently asked to provide the top reasons that IME disputes are resolved in favor of the worker. According to data on IME disputes filed by workers from August 2022 to April 2023, the top two reasons IME disputes are resolved in favor of the worker (determined as “IME not appropriate”) are: case progress (47 percent resolved in favor of the worker), and number of IMEs (22 percent resolved in favor of the worker).
Here are a few reminders to help when considering an IME:
Reason for IME:
When listing the “reason for examination” on the IME assignment letter, provide all reasons the exam is being requested. As a common example, if you schedule the first exam and only note one reason for the exam, but have the examiner provide an opinion on three topics, you likely will not be able to schedule an exam several months later for the other two topics, although you did not list those as reasons for the exam.
Case Progress:
WAC 296-23-302, Definitions, “Case progress examination.”
WAC 296-23-308, “Scheduling case progress examinations.”
A case progress examination is intended for accepted conditions and may be requested when:
- A proper and necessary treatment plan is not in place; or
- The treatment plan has stalled or been completed without objective or functional improvement for physical conditions, or clinically meaningful signs of improvement for mental health conditions.
There are two thresholds that must be met in order to schedule a case progress IME:
1. Unless a case progress IME is requested by the attending provider:
- 120 days must have passed since receipt of the claim, or
- 120 days have passed since the last case progress IME and additional treatment of the condition, if requested, has been authorized.
2. The attending provider:
- Failed to respond in a timely fashion to a request for consult, or the consultation.
- Omitted requested information.
- Did not make further treatment recommendations.
- Recommended treatment that is not proper and necessary.
- Wrote a report that doesn’t comply with WAC requirements.
Number of IMEs:
WAC 296-23-309, “How many examinations may be requested?”
One examination may be requested (unless the department authorizes an additional examination):
- Prior to an order allowing or denying a new claim.
- To adjudicate any application to reopen a claim
- Additional impairment rating examinations are allowed following each time a claim is reopened.
- After any new medical issue is contended.
- For case progress and to resolve appeals:
- For an impairment rating
- Unless a prior IME for an impairment rating determined the rating was premature and/or further treatment was authorized.
Additional resources:
IMEFAQ.pdf (wa.gov)
New Independent Medical Examination Rules Take Effect April 23 (govdelivery.com)
Questions? Email: SITrainerQuestions@lni.wa.gov
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