Tag Archives: IME

Photo credit: Ilmicrofono Oggiono on Flickr.com
Independent Medical Exam

Observer is Allowed at IMEs

The Department of Labor and Industries (DLI) recently issued a Statement of Policy advising that an observer is allowed at IMEs. Any injured worker is allowed to bring a friend of family member to an independent medical examination (IME), except in the case of a mental health examination.

IME Firms Were Limiting Observers

We have seen several IME firms include notice of “new rules” that “observers are not allowed due to COVID-19” in their pre-exam paperwork mailed to injured workers. In response to complaints about this practice, primarily from attorneys representing injured workers, DLI has now taken action by issuing the Statement of Policy confirming that an observer is allowed at IMEs. It is unknown how many workers have had exams without observers present in the last few months before this statement was issued.

Statement of Policy – the Full Text

Pursuant to WAC 296-23-362, workers have the right to bring a friend or family member to Independent Medical Exams (IMEs), except for mental health examinations, to serve in the role of observer providing comfort and reassurance. IME firms are expected to support any worker requests for an observer during a non-mental health IME. They must also refrain from any reference, in written or spoken communication with workers, to limitations on observers during IMEs. This worker right remains in effect, and it is up to the IME firm to ensure the ability to comply with the COVID-19 safety requirements for six feet of social distancing.

Firms should obtain information in advance of the IME on whether the worker plans to bring an observer and take steps to ensure the appropriate exam room size. In the event that the firm is unable to accommodate the worker’s IME with an observer, the IME will need to be rescheduled.

What This Means for Workers

The news is simple and straightforward: an observer is allowed at IMEs to support the worker. The implementation of this policy may be more complicated.

Many of the IME firm’s exam rooms are very small. It may be difficult for them to accommodate observers and follow social distancing rules. Some IME firms may try to pivot and, instead of allowing observers, insist on video exams (this is already happening with mental health evaluations). 

We recommend the following tips:

  • all workers have an observer with them during any non-mental health IME
  • make sure social distancing rules are followed
  • do not agree to video exams under nearly any circumstances
  • file a complaint if the doctor or IME firm is not following the policy
  • promptly contact a workers’ compensation attorney with any concerns about your claim or your IME
How Can an Observer Help?

An observer cannot be a legal representative or their staff nor a doctor or their staff. The primary purpose of an observer is to provide comfort and reassurance to the worker. However, an observer can corroborate the workers’ version of events that occurred during the examination process if there is later any discrepancy arising from the physician’s written report.

We suggest that an observer:

  • listen and observe the examination without distractions
  • refrain from asking questions of the physician
  • refrain from providing answers to physician questions of the worker
  • take notes with pen and paper (use of recording devices, including phones, are not usually allowed)
Recent Posts on Related Topics
government, Legislation, Workers' Compensation

“Independent” Medical Examinations in Workers’ Compensation (Anything but “Independent”)

Today’s post comes from guest author Thomas Domer, from The Domer Law Firm.

“I thought their doctor Independent Medical Report was the last word on my case. I didn’t know any better.” 

This statement from a client I just met sums up the experience of many injured workers unfamiliar with the workers’ compensation process in Wisconsin (and many other states).

An insurance company or self-insured employer may request an injured worker submit to reasonable examinations by a physician, chiropractor, psychologist, dentist, podiatrist, physicians assistant, or Advanced Practice Nurse Practitioner of its choice. Wis. Stat. §102.17(1)(b). This examination is usually referred to as an Independent Medical Examination or “IME” although “adverse medical examination” more accurately reflects the process.  An Independent Medical Examination may be requested by the insurance company or self-insured employer in order to determine whether the claim is compensable and the extent of the disability or the necessity and type of treatment. 

Since only about one in ten injured workers in Wisconsin is represented by an attorney, nine out of ten unrepresented workers are not aware that the insurance company’s “IME” is actually an adverse exam by a doctor hired by and paid by the insurance company to issue his report. Although IME examiners would deny they routinely render an opinion in favor of the insurance carrier, my forty years of experience suggests just that. For many years lawyers representing injured workers have been proposing the terminology “Adverse Medical Examination” apply to give represented and unrepresented workers a more fair assessment of the process. Many IMEs make hundreds of thousands of dollars annually performing these examinations. At one of these examinations, my client overheard the IME physician (who had rented a motel room) speaking to a prospective young doctor trying to convince that doctor to perform IMEs. “This is a great practice.” He said.  “All you have to do is review the medical records, meet with the worker for a few minutes, and deny the claim. And for that you can charge $1,500.” Although my client’s testimony to this effect was barred, the underlying accuracy of his testimony is undisputable.

Beware the “Independent” Medical Examination.

Workers' Compensation

Mileage Reimbursement Set at 56 Cents per Mile for 2014

Today’s post comes from guest author Brody Ockander, from Rehm, Bennett & Moore.

Getting reimbursed for mileage and travel expenses is often part of the medical process in a workers’ compensation claim. However, it’s essential to keep detailed receipts and have a plan for submitting those expenses in a timely manner.

The federal government has set the 2014 mileage reimbursement rate to 56 cents per mile. This rate was effective Jan. 1, 2014. This is a decrease from 56.5 cents per mile last year, but the price of gasoline is also slightly cheaper.

Generally speaking, the federal rate changes annually. However, when gas prices went soaring in 2008, a mid-year increase went into effect.

As a reminder from a blog post that firm partner Todd Bennett wrote in 2011, injured workers can be reimbursed for activities such as “travel to seek medical treatment, pick up medications, or while participating in a vocational rehabilitation plan.”

The best way to do this is to work with your attorney and legal assistant to keep track of all mileage. This can include appointments for Independent Medical Exams (IME), too. Then your attorney can help you get reimbursed. 

It is often essential to save receipts and keep a record for yourself of your doctor’s visits and other reimbursable trips, including physical therapy and trips to pick up medication. Providing that log to your attorney and saving receipts incurred from specific doctor visits and other reimbursable trips creates a “narrative” that makes it easier to justify those expenses.

Because money is always tight for injured workers, contact an experienced workers’ compensation attorney if you have questions about a specific situation.

DLI

What’s New for Independent Medical Exams in Washington State

The Department of Labor and Industries has adopted changes to the Washington Administrative Code regarding the: 

  • credentialing,
  • approval,
  • removal,  and
  • regulation of independent medical examination (IME) providers.

The rules are effective February 25, 2013.

These rules establish clear guidelines that a medical provider must follow to become an approved IME examiner. They also set the standards for IME examiners and firms to continue to receive referrals for IMEs. Rules governing the termination, suspension and discipline of IME providers and IME firms are also outlined.

Detailed information relating to this rule is provided in the CR-103 filing documents. View the CR-103 and the adopted language here.

 

 

Photo credit: <a href=”http://www.flickr.com/photos/pedrovezini/4933885107/”>Pedro Vezini</a> / <a href=”http://foter.com”>Foter.com</a> / <a href=”http://creativecommons.org/licenses/by-nc-sa/2.0/”>CC BY-NC-SA</a>