1. If the parties
agree to the selection of a particular independent medical examiner, they shall
file a form prescribed by the Board with the Office of Medical/Rehabilitation
Services, Workers' Compensation Board, 27 State House Station, Augusta, Maine
04333. If the employee is unrepresented by counsel, the independent medical
examiner agreed upon must be chosen from the Board's list of independent
medical examiners or approved by the Executive Director or the Executive
Director's designee.
2. If the
parties do not agree to the selection of a particular independent medical
examiner, the requesting party shall file a Request for Independent Medical
Examination (WCB M-2) with the Office of Medical/ Rehabilitation Services,
Workers' Compensation Board, 27 State House Station, Augusta, Maine 04333 and
follow the procedures contained in section
3 of this rule. The Executive Director
or the Executive Director's designee shall assign an examiner from the list of
qualified examiners. If the list does not contain a qualified examiner, the
Executive Director or the Executive Director's designee may select a qualified
medical examiner of his/her choice. An Administrative Law Judge may also
request an independent medical examination. The requesting party must:
A. Complete Board Form M-2 and file it with
the Office of Medical/ Rehabilitation Services, Workers' Compensation Board, 27
State House Station, Augusta, Maine 04333.
B. Attach to Board Form M-2 a joint medical
stipulation containing all medical records and other pertinent information,
including an index of all treating health care providers and examinations
performed under
39-A
M.R.S.A. §207 since the date of
injury.
3. Assignment of
a Board appointed independent medical examiner in a particular case will be
performed by the Executive Director or the Executive Director's designee from
the list of Board approved independent medical examiners with possible input
from the individual Administrative Law Judge. The assignment will be made from
a relevant area of specialty for the medical issues in question. The time it
takes to schedule an examination may be a consideration in the selection. If a
particular provider on the independent medical examiner list is precluded by
rule or statute from acting as an independent medical examiner in the parties'
case, the parties should notify the Board prior to the selection
process.
4. A Board appointed
independent medical examination under
39-A M.R.S.A.
§312 may be requested only after an
unsuccessful mediation or after a request for a provisional order has been
acted on and the case must be proceeding to the formal hearing level.
5. Parties are limited to one Board appointed
independent medical examiner per medical issue unless significant medical
change can be shown.
6.
Disqualification and Disclosure in Individual Cases
The independent medical examiner must disclose potential
conflicts of interest that may result from a relationship(s) with industry,
insurance companies, and labor groups. A potential conflict of interest exists
when the examiner, or someone in their immediate family, receives something of
value from one of these groups in the form of an equity position, royalties,
consultantship, funding by a research grant, or payment for some other service.
If the independent medical examiner performs equivalent examinations as an
employee of another organization, potential conflicts of interest may arise
from that organization's contracts with industry, insurance companies, and
labor groups. The Executive Director or the Executive Director's designee shall
determine whether any conflict of interest is sufficiently material as to
require disqualification in the event of initial disclosure. In the event an
undisclosed conflict of interest is revealed during the hearing process, the
Administrative Law Judge may disqualify the independent medical examiner and
order a new examiner which shall be assigned in accordance to this
rule.
