Wash. Admin. Code § 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.
Notes
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