Claims Adjudication Tune-Up (CAT-U)
January 2026 Edition
Welcome to Self-Insurance’s Claims Adjudication Tune-Up (CAT-U) newsletter. This is where the Washington State Department of Labor & Industries (L&I) shares best practices and information, as well as highlight opportunities for improvement. The focus of this month’s CAT-U edition is Scheduling Independent Medical Examinations (IME).
Legal corner
Washington Administrative Code WAC 296-23-309: How many examinations may be requested?
Unless explicitly required by statute, the total number of examinations per claim is limited as follows:
(1) One complete examination including report prior to an order … allowing or denying a new claim. (2) One complete examination including report(s)… for an impairment rating. (3) One complete examination including report(s)… to adjudicate any application to reopen a claim… prior to a final order under Revised Code of Washington (RCW) 51.52.050 or 51.52.060 allowing or denying reopening of the claim.…
(4) One examination may be performed after any new medical issue is contended…
(5) Additional examinations per case progress rules and to resolve appeals…
WAC 296-23-308: Scheduling case progress examinations.
(1) Unless a case progress examination is requested by the attending provider, no case progress examination may be scheduled until 120 days have passed since the later of:
(2) Subject to subsection (1) of this section, L&I or the self-insurer may schedule a case progress examination of an injured worker after:
(a) Requesting an explanation from the attending provider regarding status of the treatment plan per WAC 296-23-302, definition of case progress examination, or a referral of the injured worker to a consultation with the appropriate specialty(ies) per WAC 296-20-051 within 15 business days of the request; and
(b) The attending provider or consultant… [did not provide a sufficient reply]
Take away: Independent Medical Examinations must be scheduled for specific reasons and may be requested once to address each of these issues: allowance, impairment rating, reopening, a new medical issue, and case progress. As addressed in WAC 296-23-302, case progress examinations could be appropriate if there’s a question of whether an existing treatment plan for an accepted condition is proper and necessary, or has stalled.
News you can use
Case law/Significant decision: In re Bryan Wickstrom, BIIA Dec., 21 11055 (2023)
“As we held in In re Jeremy D. Kidder, a Functional Capacity Exam is not a ‘medical examination’ and it is not subject to the provisions of RCW 51.36.070. It is a vocational evaluation.”
Claim impact: Examinations that do not fall under RCW 51.36.070, still require reasonable worker notification. WAC 296-14-410 discusses notice to the worker at least 14 but no more than 60 days prior to the examination. The notice must tell the worker the date, time, and location of the exam.
Trainer trivia
December question: The first text message was sent in December of what year?
Answer: December 3, 1992. Engineer Neil Papworth typed “Merry Christmas” to a work colleague.
January question: Sherlock Holmes made his first appearance in “A Study in Scarlet” in 1887. Who was Arthur Conan Doyle’s real-life inspiration for the keen-minded Holmes?
More reading/resources:
RCW 51.36.070: Medical examination—Reports—Costs—Worker's rights.
Claim Adjudication Guidelines – Independent Medical Exams
Self-Insurance IME Assignment Letter
Reminders/tips from the Self-Insurance teams
If an interpreter is needed, the employer is responsible for providing one. The interpreter should not be considered the worker's chosen observer.
If you find that treatment has stalled, you may consider following the steps outlined in WAC 296-23-308 to schedule an IME or have the Attending Provider refer for a consultation.
For more information, send an email to the SI Trainer inbox.
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