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

Category: LNI News (Page 1 of 21)

Self-Insured IME Exams: L&I Implements New Rules in Washington State

The Department of Labor and Industries (L&I) implemented new rules for self-insured independent medical examinations. These rules passed the legislative section during 2019-2020. I’m happy to share that the new rules officially kicked in on April 23, 2022.

 

Rules for self-insured medical exams

There are several changes under the new regulations. The most significant updates are summarized below. The first change relates to IME scheduling and notices. Previously, self-insured claim administrators provided injured workers a 14 days notice before an IME. However, under the new rule, the new time window is 28 days.

 

The second major change has to do with the notice form. Moving forward, self-insurers must include a standard form to notify workers’ compensation claimants of an upcoming IME. The form is available on the L&I website (although I wasn’t able to find it). More importantly, the form mandates insurers to provide critical information to workers. For one, it has to include the reason for the IME request.

 

Disputing independent medical exams in self-insured claims

The third rule change focuses on IME disputes. Here, workplace injury claimants can dispute upcoming IME exams. Moreover, the worker’s attending provider can also dispute an IME. Either way, it’s important to file the IME dispute at least 15 calendar days before the exam. The dispute must specify the reasons why the IME is inappropriate. In turn, L&I may postpone the IME. Moreover, there’s a very interesting case when an IME exam is under dispute yet the claimant attends it. If L&I determines the IME was in violation of RCW 51.36.070, then the IME report can’t be part of claim administration.

 

No more infinite IME exams

The fourth area of change is around the number of IME exams. From here on, there’s a limit on the number of independent medical exams that self-insurers can request. The actual number depends on the underlying issues and the reason for the IME. For example, IME doctors can perform only one exam when contending a new medical issue. The purpose of the one-time IME is to resolve the new medical issue before issuing a final order.

 

The fifth and final change I wanted to cover is for case-progress IME criteria. This happens when self-insured claim managers request an IME for accepted conditions. More explicitly, L&I considers IME exams for accepted conditions as case-progress exams. Self-insurers can only request these exams when:

1) The worker is not receiving necessary and proper treatment; or

2) Treatment stalled without any real improvement to physical or mental conditions.

 

So – what’s next?

The new rules are fresh out of the over. They are so new that it isn’t clear how they’ll impact the claim administration process. However, I applaud L&I for adopting the new rules. Clearly, they help protect work injury claimants. The changes eliminate excessive and inappropriate IME requests. These unnecessary IME exams tend to impede and inhibit productive claim progress.

 

The L&I Double Standard: Workplace Safety vs Medical Coverage

I regularly applaud and give praise to the Department of Labor and Industries (L&I) when praise is due. In particular, I’m always impressed with L&I’s workplace health and safety programs. L&I dedicates tremendous resources to studying and improving safety for workers. Moreover, the L&I website contains helpful information for employers and workers alike. On top, people can sign up to health and safety newsletters. These email-newsletters comprise valuable and important information.

 

A recent L&I safety publication

Recently, L&I sent a newsletter with the subject “Be Kind to Your Neck and Shoulders”. It caught the attention of workers’ compensation attorneys like me who represent work injury claimants. The reason it caught our attention is because it lists causes of neck and shoulder injuries. However, the newsletter’s safety topics are ones that L&I often ignores when it comes to medical coverage.

 

L&I’s own guideline not covered by workers’ comp insurance

According to the publication “working with your hands overhead can cause neck and shoulder problems. Disposition can reduce blood flow to your neck and shoulders causing you to tire out quickly. Problems can begin after 30 minutes of overhead work per day”. I concur.

 

Now, say that workers perform overhead lifting only 30 minutes out of an 8 hour workday. That’s less than 7% of the day. Yet, according to L&I definitions, an activity that’s done for 1-10% of the day is a “seldom” activity. In my experience, when a person suffers a work injury from seldom activities, there’s higher likelihood for questioning causation. In fact, chances for doubting causation increase when L&I asks IME doctors to weigh in on causation.

 

Industrial insurance coverage in the L&I claim settings

I’m a workers’ compensation attorney representing work injury claimants. The L&I double-standard in this example is extremely frustrating to me. It appears that L&I acknowledges that 30 minutes of daily overhead reaching can result in shoulder injury. However, as it turns out, it only applies to safety procedures. It doesn’t apply to actual L&I claim coverage. I don’t think it’s fair. It would only be fair if L&I applies the same standard when evaluating causation for industrial insurance coverage.

The Most Important Thing in Workers’ Compensation Claims: Safety First!

I’ve been representing work injury claimants for nearly 20 years. I don’t want to say that I’ve seen it all. I’m sure I haven’t. But I’ve seen a lot. During a standard day, I take approximately 3-5 claim consultations. Usually, while on the phone with injured workers, we spend a lot of time discussing workers compensation claim outcomes. If anything, there’s one top thing I’ve learned to date. No claim outcome is better than not getting injured in the first place!

 

Improving safety means less work injuries

Many organizations are committed to improving workplace safety. Here, at state level in Washington State, we have the Department of Labor and Industry (L&I) and WISHA. Then, at the federal level, there’s OSHA and NIOSH. In general, most employers also work very hard to eliminate work injury occurrences. After all, fewer workplace injuries mean lower workers’ comp claim costs. It also means lower employer premiums, and less loss of productivity.

 

How a workers’ comp attorney views workplace safety

Many people ask me what I do. What does it mean to be a workers’ compensation attorney? Usually, I say that I help people navigate the most challenging and life altering event of their lives. Remember- fewer workplace injuries means fewer work injury claimants who have to endure these challenges. We must acknowledge that all participants play a key role here. Federal organizations, state agencies, employers, and workers. Therefore, I can’t stress enough the importance of doing your part. For me, my primary concern is obviously the worker. KEEP YOURSELF SAFE IN THE WORKPLACE!

 

What can I do to avoid a workplace injury?

There are many things that workers can do to improve their personal safety at work. For one, you should know your work environment. Knowing the layout, hazards, emergency routes, and environment can help workers spot dangerous situations. On top, it can also help workers get out of a dangerous circumstances or minimize injury. More importantly, identifying unsafe situations can prevent accidents before they happen.

 

Another way to reduce injuries is to learn how to use equipment safely. It’s critical to know how to properly operate tools, machinery, and other office equipment. Sometimes, there are certain procedures that you must follow. Here, obeying to simple procedures can dramatically reduce the likelihood of getting injured while operating equipment.

 

What are other ways to improve safety at work?

It’s also very important to take regular breaks. Taking breaks isn’t about being lazy. Additionally, it’s not about shirking job responsibilities. Studies show that taking breaks reduces fatigue and burnout. Furthermore, it improves attention, concentration, and thought clarity. Being alert, focused and clear is another great way to reduce the chance of suffering a work injury.

 

In general, we also recommend coming to work rested. While it’s not always possible, it’s very important. Fatigue leads to mistakes and reduces reaction times. Both factors can be a recipe for disaster in the work setting.

 

Other tips to reduce work accidents

Finally, it’s important to maintain good body mechanics. Body position is extremely important. This is true for both sedentary workers and physically demanding jobs. More explicitly, you can maintain good body mechanics through good posture, safe maneuvers, and movements. You can also pay attention to ergonomics, and appropriate body conditioning. These are all great ways to decrease the probability of workplace injury.

 

In summary, as workers, we must remember that organizations and employers are working to reduce the frequency of injuries in the workplace. However, it’s not only on them. It’s also on us. It’s up to us to take steps to protect ourselves. There is no greater workers’ compensation benefit than not suffering an injury in the first place.

 

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