Medical Examiners’ Handbook July 2021 Update Impairment Ratings and Independent Medical Examinations in Washington State Workers’ Compensation For IME Examiners, Attending Doctors and Consultants Free 3 Hours Category 1 CME Credit The Department of Labor and Industries (L&I) is accredited by the Washington State Medical Association to provide continuing medical education for physicians. L&I designates this type of enduring material for a maximum of 3 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity meets the criteria for up to 3 hours of Category 1 CME credit to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission. Accreditation: Approval Date — July 1, 2021 Expiration Date — June 30, 2024 This publication contains guidelines, sample reports, and billing procedures for preparing and conducting impairment ratings and independent medical exams (IME) in Washington’s Workers’ Compensation system. The activity was planned and produced in accordance with the WSMA Essential Elements, Criteria, and Standards of Accreditation of Continuing Medical Education. Disclosure: None of the faculty involved with developing this handbook or self assessment test online has any financial relationship to disclose nor do they financially benefit from this product. First published April 1990 PUBLICATION F252-001-000 [07-2021] About the July 2021 Updated Medical Examiners’ Handbook The July 2021 updated edition of the Medical Examiners’ Handbook contains selected updates to the July 2020 edition. New or updated information is listed in the table below. Updates and Additions to the Medical Examiners’ Handbook, July 2021 Chapter Page Title Comments Cover Handbook Cover Page Updated with current dates including CME accreditation dates 1 3 Legislative Intent Added information regarding the 2020 legislative changes 1 4 Reasons Why IME are Update language per new legislation Requested 1 5 Confidential Clarified what an examiner designee is Information/Medical Records 1 7 Scheduling IMEs Added language regarding reasonably convenient and added clarifying language to the ‘Important Note’ 2 10 Types of Examiners Added note to see Chapter 13 to clarify billing differences between IMEs and Impairment ratings 2 18 Important to Know Added fax and phone numbers for Provider Quality and Compliance unit; added reminder to notify department of any change in information or availability 3 20 Preparing for the Exam/ Added language regarding telehealth scheduling as an option scheduling 3 21 Interpreter services Added language and links for the new interpreter scheduling system 3 24 Releasing Information to Update language related to SSB 6440. The department or self-insured employer Other Parties will provide a copy of the IME report to the AP and worker. 3 25 Telehealth/Telemedicine New section added including information regarding examiner responsibilities when scheduling telehealth exams. 4 33 Treatment Guidelines No updates 4 34 Pain Management and Additional language added regarding who to contact with prescribing concerns Opioid Prescribing 4 34-35 What to Avoid in the Clarified language regarding conditions accepted by the department. Added what Examination or Report to do about incidental findings 7 51-55 Preparing for Your Mental Add Language to the presumption section for firefighters/law enforcement. Health Report Updated requirements regarding WHODAS 8 60-62 Vocational Issues & Updated language to match preferred terminology. Removed Job Analysis 66-69 Physical Restrictions Summary form and added Job Analysis form 9 70-73 Providing Testimony Minor clarification edits, pages 70, 71, and 73 13 139-140 Billing for an IME Added clarifying language regarding when IME codes can be billed Append C 172-179 Relevant Laws and Updated RCW 51.08.142, 51.32.110, RCW 51.36.070 Regulations Append C 172-179 Relevant Laws and Added new RCW 51.08.121 Regulations Table of Contents Preface ........................................................................................................................... 1 CHAPTER 1 ............................................................................................... 2 Workers’ Compensation in Washington State ............................................................ 2 Background ........................................................................................................................................... 2 Legislative Intent & Department Role ................................................................................................... 2 Reasons Why IMEs are Requested ...................................................................................................... 3 Additional Types of Examinations ......................................................................................................... 4 Confidential Information ........................................................................................................................ 5 Claim Manager Role ............................................................................................................................. 6 Scheduling IMEs ................................................................................................................................... 7 CHAPTER 2 ............................................................................................. 10 The Independent Medical Examination Provider ...................................................... 10 Types of Examiners ............................................................................................................................ 10 Application Process............................................................................................................................. 11 Examiner Credentialing Requirements ............................................................................................... 11 Additional Requirements for Specific Examiner Specialties: .............................................................. 12 Examiner Training Requirements and Opportunities .......................................................................... 14 Site Standards and Business Requirements ...................................................................................... 14 Independent Medical Examination Firms ............................................................................................ 15 Requirements for IME Firm Providers ................................................................................................. 15 Review of Applications ........................................................................................................................ 17 Reporting Changes to L&I ................................................................................................................... 17 CHAPTER 3 ............................................................................................. 20 The Independent Medical Exam ................................................................................. 20 Preparing for the Examination / Scheduling ....................................................................................... 20 Missing Documents or Records .......................................................................................................... 20 Interpreter Services ............................................................................................................................. 21 Who is Allowed to Attend an IME? ...................................................................................................... 21 May the Worker Record the IME? ....................................................................................................... 21 Examiner Responsibilities ................................................................................................................... 22 Discussing the Examination Results with the Worker ......................................................................... 23 May I Offer to Provide Ongoing Treatment? ....................................................................................... 23 Ordering Diagnostic Tests .................................................................................................................. 23 Unable to Complete Examination ....................................................................................................... 23 Additional Examiner Needed .............................................................................................................. 24 No Show or Late Cancel ..................................................................................................................... 24 Releasing Information to Other Parties ............................................................................................... 24 Medical Records - Maintenance and Disposal ................................................................................... 25 Worker’s Questions about their Claims............................................................................................... 25 Telehealth/Telemedicine ..................................................................................................................... 25 Medical Examiners’ Handbook 07-2021 CHAPTER 4 ............................................................................................. 26 The IME Report ...........................................................................................................