Transcription of July 2021 Update
1 Medical Examiners Handbook July 2021 UpdateImpairment Ratings and Independent Medical Examinations in Washington State Workers CompensationFor IME Examiners, Attending Doctors and ConsultantsFree 3 Hours Category 1 CME CreditThe Department of Labor and Industries (L&I) is accredited by the Washington State Medical Association to provide continuing medical education for 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 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 : 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.
2 The activity was planned and produced in accordance with the WSMA Essential Elements, Criteria, and Standards of Accreditation of Continuing Medical : 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 published April 1990 PUBLICATION F252-001-000 [07-2021]Free 3 Hours Category 1 CME CreditAbout 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 Requested Update language per new legislation 1 5 Confidential Information/Medical Records Clarified what an examiner designee is 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.
3 Added reminder to notify department of any change in information or availability 3 20 Preparing for the Exam/ scheduling Added language regarding telehealth scheduling as an option 3 21 Interpreter services Added language and links for the new interpreter scheduling system 3 24 Releasing Information to Other Parties Update language related to SSB 6440. The department or self-insured employer 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 Opioid Prescribing Additional language added regarding who to contact with prescribing concerns 4 34-35 What to Avoid in the Examination or Report Clarified language regarding conditions accepted by the department. Added what to do about incidental findings 7 51-55 Preparing for Your Mental Health Report Add Language to the presumption section for firefighters/law enforcement.
4 Updated requirements regarding WHODAS 8 60-62 66-69 Vocational Issues & Physical Restrictions Updated language to match preferred terminology. Removed Job Analysis 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 Regulations Updated RCW , , RCW Append C 172-179 Relevant Laws and Regulations Added new RCW Medical Examiners Handbook 07-2021 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.
5 10 Types of Examiners .. 10 Application 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.
6 24 Releasing Information to Other Parties .. 24 Medical Records - Maintenance and Disposal .. 25 Worker s Questions about their 25 Telehealth/Telemedicine .. 25 Medical Examiners Handbook 07-2021 CHAPTER 4 .. 26 The IME Report .. 26 Unbiased, Accurate IME Reports Contribute to Equitable Treatment of Workers .. 26 Due Date for IME Reports .. 26 Late Reports .. 26 What to Include in an IME Report .. 26 Details to Include in the Report .. 28 Radiology Reporting Requirements for IMEs .. 29 When to Sign the IME Report .. 30 Where to Send the IME Report .. 30 When Examiners Disagree on IME Conclusions .. 30 Addendum Report .. 31 What is Meant by more-probable-than-not in an IME? .. 31 Maximum Medical Improvement (MMI).. 31 Treatment Recommendations .. 32 Guidelines, Coverage Decisions, and Policies on Specific Medical Conditions and Treatment Recommendations .. 33 Pain Management and Opioid Prescribing.
7 34 What to Avoid in the Examination or Report .. 34 If the Injured Worker needs Treatment from a different provider .. 35 Reopening a Closed Claim (worsening, objective findings) .. 35 CHAPTER 5 .. 38 Preexisting Conditions, Lighting Up, and Segregation .. 38 When does L&I accept full responsibility for a preexisting condition? Lighting Up .. 39 When does L&I accept limited responsibility for a preexisting condition? Segregation .. 39 When does L&I deny responsibility for a preexisting condition? .. 39 What should I do to address preexisting conditions? .. 40 CHAPTER 6 .. 42 Occupational Diseases .. 42 The Occupational Disease Report .. 42 CHAPTER 7 .. 48 Mental Health IME reports .. 48 Diagnosis and Baseline .. 48 Causation .. 49 Ability to Work / Work Restrictions .. 49 Job Analysis .. 50 Maximum Medical Improvement (MMI) or Treatment .. 50 Impairment Rating .. 50 Preparing for your mental health report - Definitions, WACs, and Background.
8 51 CHAPTER 8 .. 60 Vocational Issues & Physical Restrictions .. 60 Job Analyses and/or Job Descriptions .. 60 Reviewing a Job Analysis or Job Description .. 61 Medical Examiners Handbook 07-2021 Addressing Current Physical Capabilities .. 61 Common Household/Work Items .. 64 Job Analysis Form .. 66 CHAPTER 9 .. 70 Providing Testimony .. 70 Examiner Responsibility .. 70 Deposition or Live Testimony .. 71 Fee Schedule for Testimony .. 71 Appeal Process .. 72 CHAPTER 10 .. 74 Complaints about the Independent Medical Exam .. 74 Complaints or Comments about an IME .. 74 Types of Complaints .. 74 Possible Department Actions .. 75 CHAPTER 11 .. 76 Impairment Rating- General Information .. 76 The Difference between impairment and disability, and why it is important .. 76 Is an IME the Same as an Impairment Rating Examination? .. 76 Who May Rate Impairment? .. 76 When to Rate Impairment.
9 77 The Five Required Components of ALL Impairment Reports .. 77 Medical Judgment in the Rating Process .. 78 Objective Findings in the Rating Process for Physical and Mental Health Impairment .. 78 What Rating Systems Should I Use? .. 78 How are Injuries Prior to October 1974 Handled? .. 82 How is Pain Considered in an Impairment Rating? .. 83 Does the Rating Process Include Consideration of the Worker s Financial Need? .. 83 CHAPTER 12 .. 84 Impairment Rating - Detailed Instructions .. 84 Rating and Technical Assistance .. 84 Detailed Instructions for Rating Various Body Systems .. 84 American Medical Association Guides - General Instructions .. 85 Back Impairment .. 85 Cervical and Lumbo-Sacral Guidelines, Case Examples .. 85 Cervical and Cervico-Dorsal Spine .. 85 Guidelines For Cervical and Cervico-Dorsal 87 Dorsal Spine .. 89 Dorso-Lumbar and Lumbo-Sacral Spine Impairment.
10 91 Guidelines For Dorso-Lumbar and Lumbo-Sacral Impairment .. 93 Pelvis .. 96 Cardiac .. 97 Convulsive Neurologic Disorders (Seizure Disorders, Epilepsy) .. 97 Medical Examiners Handbook 07-2021 Dental, Tooth Loss .. 98 Digestive Tract .. 99 Upper Digestive Tract .. 99 Lower Digestive Tract .. 99 Anal Function .. 100 Liver and Biliary Tract .. 100 Extremity Ratings (Upper and Lower) .. 101 AMA Guides and RCW .. 101 Rating Extremities Other Than Amputations .. 105 Hearing Loss .. 106 AMA Guides and Worksheet .. 106 Audiometric Testing .. 106 Presbycusis .. 107 Tinnitus .. 107 Hearing Impairment Calculation Worksheet .. 109 Hernia (Inguinal, Umbilical, etc.) .. 111 Mental Health .. 111 Cognitive Impairment vs. Mental Health Impairment .. 111 Stress Not Covered .. 111 General Requirements for Rating Mental Health Impairment .. 112 Rules (WAC 296-20-330) .. 113 Categories (WAC 296-20-340).
