Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

Category: IME (Page 4 of 5)

L&I Claim and Independent Medical Exam (IME) Providers from Out of State

Recently, I’ve been very busy wrapping up litigation in several cases. The litigation was before the Board of Industrial Insurance Appeals (known as BIIA or Board in short). The appeals in question were filed by work injury clients, which I represent. In general, an L&I claim appeal is filed after we receive an L&I claim decision that we disagree with.

 

L&I claim appeal: Testimony and cross examination

During litigation, I present evidence supporting the appeals on behalf of my clients. The evidence is primarily testimony from medical and vocational expert witnesses. Generally speaking, we present expert testimony by deposition. Therefore, it can take months before all the testimony is complete. In this case, it took us over 3 months.

 

The Department of Labor and Industries (L&I) and self-insured employers have their own expert witnesses. As these workers’ compensation claim appeal cases were winding down, I’ve been busy with cross examination. Cross-exam is my chance to ask them questions. Interestingly, most of the medical witnesses in recent cases were L&I claim IME providers.

 

L&I claim IME doctors from outside Washington State

Let’s focus on the 3 most recent depositions of L&I claim IME providers. Surprisingly, I found out that all 3 are not from Washington State. In fact, none of them ever treated patients in Washington State. The only reason they have a license to practice medicine here is to do IME exams for a workers’ compensation claim.

 

They testified that they fly here for a week, once every four or five weeks. When they come, they spend four to six days performing IME examinations for work injury claims. These providers do anywhere from 2 to 10 IME exams each day. On average, they run 6 examinations per day. Furthermore, L&I and self-insured employers usually ask for their opinion and testimony to support their position. They rarely (if ever) testify to support work injury victims.

 

L&I workgroup to evaluate IME procedures

In March 2020, new legislation prompted L&I to create a workgroup and evaluate the IME process. For one, the workgroup was supposed to figure out how to retain more in-state physicians for IME exams. On top, they tried to develop strategies to reduce the number of IME tests in L&I claims. Moreover, they were going to consider the work injury claimant’s rights as they relate to an IME. The workgroup mandate expired December 31, 2020.

 

Frankly, I don’t know the results of the workgroup efforts. However, I’m glad the legislature acknowledged the need to address these issues. Like me, every workers’ compensation attorney knows that IME exams are necessary in a workman’s comp claim. Yet, as an L&I attorney representing people after a work injury, I often question the “independent” nature of the exam. In fact, some practitioners refuse to call them “independent”.

 

My personal take

I find it hard to accept that IME exams are independent. I mean, we rarely see IME tests that are favorable to work injury claimants. Also, the costs of these medical examinations are disconcerting. For example, I recently reviewed an IME bill for more than $2000 for one time evaluation and record review. No wonder doctors from other states get their license in Washington State and fly out to do these exams.

 

I hope the L&I workgroup made some good progress regarding IME procedures. I’m also hopeful that we’ll see improvements for more fairness towards work injury claim clients. Personally, I’d like to see L&I reduce the excessive costs associated with these kinds of examinations. Finally, I wish L&I succeeds in recruiting more Washington State doctors and other providers to help with L&I claim matters.

 

Workers’ Compensation Claim: The Importance of Objective Medical Findings

Objective medical findings are very important in every L&I claim and workers’ compensation claim. The Department of Labor and Industries (L&I) distinguishes between objective and subjective findings. For example, when a work injury claimant describes their symptoms, that falls under subjective findings. However, medical exam results where a treatment provider can see, feel, or measure, are objective.

 

L&I claim time-loss certification

L&I requires objective findings before they can provide certain benefits. This fact applies to both work injury and industrial disease. One example is time loss compensation benefits. You must certify time-loss before L&I can remit payments. To certify time-loss, a treating provider must complete an activity prescription form (APF). Then, the provider should attach chart notes to document their findings. In fact, the APF contains a mandatory section asking providers to list “measurable objective findings”. Here, examples include things like positive x-rays, swelling, muscle atrophy, and range of motion.

 

Objective medical findings in an L&I claim

I frequently investigate L&I claims for work injury victims that are not getting time loss payments. Very often, I discover it’s because they didn’t identify objective medical findings. Sometimes, it’s an oversight that anyone can correct easily. Other times, it’s because there are no objective findings.

 

In reality, some provides have their own definition for “objective”. In more troubling cases, L&I denies x-Ray or MRI exams that would objectify the worker’s complaints. Either way, I think it’s extremely important to identify objective medical findings and communicate them to L&I clearly. In fact, I routinely help my clients ensure that providers submit objective findings to L&I.

 

Reliance on objective findings

Personally, I find that many work injury claimants struggle to understand the concept of objective medical findings. Many believe that since they are in pain, then it’s enough for them to describe the pain. Unfortunately, pain is a subjective complaint. Therefore, it’s absolutely critical for treatment providers to identify underlying objective medical findings that explain the source of the pain.  Furthermore, under the law, if there are objective findings, then medical providers may also consider subjective complaints when deciding things like whether a person can go back to work.

L&I Claim and IME Exams During COVID

Workers’ comp claim administrators can ask people with a work injury claim to attend an Independent Medical Examination (IME).  The IME exam is a standard procedure and an integral part of your L&I claim. This fact remains true during COVID.  The Department of Labor and Industries (L&I), self-insured employers and their third-party administrators continue to request IME tests during COVID. If a work injury claimant refuses to attend without good cause, they may receive a penalty. Here, penalties might include a missed-appointment fee or even suspension of benefits under the workers’ compensation claim.

 

Concerns for people with a workers’ comp claim

Many people with a workmans comp claim raised concerns about this issue. In fact, here’s a short list of question I heard people ask about their IME exam during COVID-19:

1. If I am “at risk” when it comes to COVID, or if one of my household members is “at-risk”, must I attend the test in person?

2. Say that I live in a county with low Corona-virus infection rate. Do I have to travel to another county with higher infection rate for my medical exam?

3. What if I have an L&I claim but I live outside of Washington State? Must I travel to Washington State and attend the IME in-person?

4. Are there telemedicine IME exams as an alternative?

5. I have an IME exam for my workers’ comp claim. Can I bring an observer with me to the test?

Overall, claim administrators have been reasonably accommodating (so far) during COVID. If a work injury victim has a valid reason for not attending an IME, then you can usually reschedule without penalty.

 

Valid reasons to reschedule an IME exam under your L&I claim

In my experience, L&I claim managers accept several reasons for rescheduling medical exams. For example, if you are at an age that’s higher risk for COVID complications. Also, if you have health conditions that can put you, or people that live with you, “at-risk” for Corona-virus complications. Moreover, another good reason is feeling unsafe leaving home or traveling to areas with higher infection rates. Finally, when applicable, feeling uncomfortable with interstate travel to attend an IME.

 

 

Virtual IME exam

Telemedicine is another alternative. L&I indeed permits online virtual IME tests through telemedicine.  However, as of the date of writing this article, L&I didn’t offer online IME exams to any of my clients. Therefore, I can’t say how successful such tests might be.

 

Additionally, it’s important to note that some medical panels refuse to allow workplace injury victims to bring an observer. This isn’t right because work injury claimants have the right for an observer, regardless of COVID. In fact, L&I recently reminded the IME panels that work injury claimants have this right.  Consequently, some providers now require people to call in advance if they plan to bring an observer.

 

Final remarks and notes

In summary, IME tests are occurring during COVID.  Often, workplace injury claimants with a good reason can request to reset the exam without penalty. On top, L&I authorized telemedicine IME providers as an alternative to attending in-person. Most importantly, if you have an L&I claim, know that you have the right to bring another person to observe the exam. You may need to let the IME panel know in advance, however that is your right!

 

If the panel doesn’t permit you to bring an observer, you should report the incident to L&I right away. If this happens, it’s probably a good idea to consult with a workers’ compensation attorney as well.

 

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