July 2021 Update

Medical Examiners' Handbook July 2023 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 & 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)TM. 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: Original Activity Date -- July 1, 2018

Renewal 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 [07-2023]

About the July 2023 Updated Medical Examiners' Handbook

The July 2023 updated edition of the Medical Examiners' Handbook contains selected updates to the July 2022 edition. New or updated information is listed in the table below.

Updates and Additions to the Medical Examiners' Handbook, July 2023

Chapter Page Title

Comments

1

1

Preface

Updated language and added new Associate Medical Director signature

2

10

Types of Examiners

Added language that IMEs involve clinical medicine

2

10

Types of Examiners

Updated language regarding single chiropractic examinations

2

13

Additional Requirements Added link for chiropractic consultant requirements

for Specific Examiner

Specialties

3

21

Interpreter Services

Updated Important Note with information regarding sign language LAPs

3

22

Who is Allowed to Attend Rule change. Updated language to reflect changes to RCW 51.36.070 per

an IME

Substitute House Bill 1068

3

22

May the Worker Record Rule change. Updated language to reflect changes to RCW 51.36.070 per

Substitute House Bill 1068.

3

26

Telehealth/Telemedicine Updated language and added reference to the new telehealth rules, WAC 296-23-

359.

Important Note added. Must state in report if the exam was conducted via

telemedicine

4

30

What to include in the Important Note added. Include in the report whether the exam was recorded.

report

4

35

Treatment guidelines

No updates

7

50-61 Mental Health IME Reports Edits and updates added regarding Mental Health impairments and

notes regarding neuropsychological testing

8

62-71 Vocational Issues &

Minor edits and updates added

Physical Restrictions

Forms updated

10

74-75 Complaints about the Added language about Civil Rights/Human Rights complaints

Independent Medical

Exam

11

84

Rating System table

Clarified urinary and reproductive rating systems

12

104 Extremity Ratings (Upper Clarification added regarding extremity impairments

and Lower)

12

131-132 Urinary and Reproductive Clarification added regarding rating systems and added female reproductive

Systems

organs

12

134 Vision

Corrected typo under Sample Rating Report #1

13

140-142 Billing Information

Minor edits for clarification.

Chapter Page Title

Comments

Appendix 170 B

Safety for Examiners and Added language regarding abusive behavior and language from claimants Staff

Appendix 180-181 Relevant Laws and

C

Regulations

Updated RCW 51.36.070 ? Medical examination ? Report - Costs

Appendix 181-182 Relevant Laws and

C

Regulations

Updated WAC 296-14-300 ? Mental condition/mental disabilities

Appendix 205 C

Relevant Laws and Regulations

New WAC 296-23-359 effective 2023 ? Telemedicine for IME

Appendix 205 C

Relevant Laws and Regulations

WAC 296-23-362 will be amended soon. Please refer to RCW 51.36.070.

Appendix 205 C

Relevant Laws and Regulations

WAC 296-23-367 Repealed ? May the worker videotape or audiotape the independent medical examination

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 .......................................................................... 13 Site Standards and Business Requirements ...................................................................................... 14 Independent Medical Examination Firms............................................................................................ 14 Requirements for IME Firm Providers................................................................................................. 15 Review of Applications ........................................................................................................................ 16 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?...................................................................................................... 22 May the Worker Record the IME?....................................................................................................... 22 Examiner Responsibilities ................................................................................................................... 22 Discussing the Examination Results with the Worker......................................................................... 23 May I Offer to Provide Ongoing Treatment? ....................................................................................... 23 Ordering Diagnostic Tests .................................................................................................................. 24 Unable to Complete Examination ....................................................................................................... 24 Additional Examiner Needed .............................................................................................................. 24 No Show or Late Cancel ..................................................................................................................... 24 Releasing Information to Other Parties............................................................................................... 25 Medical Records - Maintenance and Disposal ................................................................................... 25 Worker's Questions About Their Claims ............................................................................................. 25 Telehealth/Telemedicine ..................................................................................................................... 26

CHAPTER 4 ............................................................................................. 28

Medical Examiners' Handbook 07-2023

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download