HTML has links - PDF has Authentication
296-15-4318  <<  296-15-440 >>   296-15-450

PDFWAC 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?
(1) The department will consider whether:
(a) The notification letter included the self-insured employer's need for the IME consistent with RCW 51.36.070 and how this may be disputed by the worker.
(b) Notice of the IME was mailed to the injured worker and the worker's representative no later than 28 calendar days prior to the IME. Except for an IME scheduled to make a decision regarding claim allowance.
(c) The worker agreed to waive the 28-day notice for initial IME scheduling or reschedules.
(2) When a written dispute is filed:
(a) A worker or their attending provider may file a dispute at any time during the IME process. Disputes received by the self-insurer or third-party administrator must be submitted to the department within five working days of receipt.
(b) The department will only consider postponing an IME if the dispute is received by the department at least 15 calendar days prior to the IME.
(c) The dispute should include the specific reason(s) why the IME is out of compliance with RCW 51.36.070 and a copy of the notification letter from the self-insured employer.
(3) The department will take action as follows:
(a) Where the dispute presents a factual case that the examination was scheduled in violation of RCW 51.36.070 or these rules, pending a further investigation, the department may order the self-insurer to cancel the IME, and to notify the examiner, worker, and attending provider. The facts the employer provides in the IME notification letter, and the facts supplied by the worker or their attending provider will be used in this determination.
(b) The department will issue an order to resolve the dispute in accordance with RCW 51.52.050.
(c) Should a worker attend a disputed IME and, after a report is rendered, the department determines the IME was scheduled in violation of RCW 51.36.070, the report may not be considered in the administration of the claim.
[Statutory Authority: RCW 51.04.020, 51.04.030, and 51.36.070. WSR 22-07-110, ยง 296-15-440, filed 3/23/22, effective 4/23/22.]
Site Contents
Selected content listed in alphabetical order under each group